Celiac Disease Beyond the Gut: Stress, Inflammation & HPA Axis Dysregulation

In this episode, registered dietician and celiac disease specialist Erin Kenny joins host Dr. Jaclyn Smeaton to discuss the differences between celiac disease and gluten sensitivity, the social and emotional toll of diagnosis, and common myths and misinformation. 

Their conversation also covers: 

• The underestimated social and emotional burden of the disease 
• How less symptoms do not equate to less intestinal damage 
• Hidden drivers behind symptoms, including dysbiosis, hormonal issues, thyroid dysfunction, and nervous system dysregulation 
• The physiological effects of stress 
• How DUTCH testing can help identify HPA axis dysregulation 

Show Notes 

Learn more about Erin Kenny and follow her on Instagram @the_celiac_space! 

Become a DUTCH Provider to get access to comprehensive patient reports, peer-reviewed and validated research, and expert clinical support. 

Transcript

00:00:00:00 - 00:00:12:14
Erin Kenny
You're on a gluten free diet and you're still having issues. We want to find the root cause. We want deeper. We want to get more data. And so the DUTCH test is really the best way for us to get a good picture of their stress response from cortisol, as well as their hormone needs.

00:00:12:15 - 00:00:37:22
Dr. Jaclyn Smeaton
Welcome to the DUTCH podcast, where we dive deep into the science of hormones, wellness and personalized health care. I'm Doctor Jaclyn Smeaton, Chief Medical Officer at DUTCH. Join us every Tuesday as we bring you expert insights, cutting edge research, and practical tips to help you take control of your health from the inside out. Whether you're a health care professional or simply looking to optimize your own well-being, we've got you covered.

00:00:38:00 - 00:00:59:21
Dr. Jaclyn Smeaton
The contents of this podcast are for educational and informational purposes only. This information is not to be interpreted or mistaken for medical advice. Consult your health care provider for medical advice, diagnosis and treatment. Hello and welcome to this week's episode of the DUTCH Podcast. Today we're going to talk about celiac disease and all of the different aspects of managing celiac disease.

00:01:00:02 - 00:01:29:08
Dr. Jaclyn Smeaton
My guest has celiac herself and also is a dietitian and nutritionist who works with celiac patients. And really, what I learned in this conversation is that, of course, we're going to talk about nutrient restoration and about gut health and how to improve gut health with gluten avoidance and other support. But there's so much complexity when patients have celiac disease, because there's all this added stress around eating, there can be effects on your mood, your ability to engage in your social life, that it becomes really complex.

00:01:29:08 - 00:01:55:14
Dr. Jaclyn Smeaton
So if you look at it only from a nutritional angle or a gut healing angle, you're really missing a huge part of the story, including things like cortisol and HPA axis dysregulation, which is really where the DUTCH test comes in. My guest is Erin Kenny. She's a registered dietitian nutritionist and the CEO and founder of the Celiac Space, which is a specialized nutrition practice dedicated to helping people with celiac disease reclaim their health overall.

00:01:55:16 - 00:02:26:00
Dr. Jaclyn Smeaton
Like I said, she has celiac herself, and Erin brings his personal and professional expertise into her work. She's spent years translating the science of celiac disease into practical, sustainable guidance for her clients at the celiac space. She leads a team of registered dietitians who are all focused on helping people navigate just the complexity of celiac management. Starting with the nutrient rehabilitation and gut healing, but also the emotional and neurological dimensions of living with this chronic autoimmune condition.

00:02:26:06 - 00:02:35:03
Dr. Jaclyn Smeaton
I think you're going to really love this conversation. Let's go ahead and welcome our guest. So, Erin, I'm so happy to have you on the pod today. Thank you so much for joining me.

00:02:35:05 - 00:02:36:16
Erin Kenny
Thanks for having me.

00:02:36:18 - 00:02:48:21
Dr. Jaclyn Smeaton
Well, I want to start out because, you know, you've become a celiac specialist, but this comes from your own personal experience of having celiac yourself. Tell me a little bit about how your own diagnosis has shaped the way that you care for patients.

00:02:48:23 - 00:03:10:12
Erin Kenny
Yeah. Great question. So I was actually diagnosed with celiac in high school long before my experience into the medical space really began. And so when I actually started becoming a dietitian, I really wanted to focus on sports nutrition and kind of optimizing people and their health. And as I got into it, I did work in the sports space for a while.

00:03:10:14 - 00:03:32:04
Erin Kenny
But I kind of stumbled upon people with celiac disease like myself who really struggled. And I realized that there was such a big community of people that just didn't have the support and resources. There's so many myths online that are bananas, to be honest, like reading them. Back then when I started the celiac space, it was shocking to see how little support people had.

00:03:32:05 - 00:03:48:09
Erin Kenny
And so I knew that I was in the unique seat of somebody that had the medical education that had lived with celiac disease to really support these people. And so that kind of began my journey into the celiac space. Of providing, you know, support and education and resources to this community.

00:03:48:11 - 00:03:51:12
Dr. Jaclyn Smeaton
You got to share what some of these craziest myths where that you came across.

00:03:51:14 - 00:04:18:13
Erin Kenny
Oh my gosh. Can I eat or, if my house is getting remodeled and they're redoing the drywall, will I get sick? Like, if they're gluten and drywall, does my tampons have to be gluten free? I don't know. I mean, I saw people I probably like, one of the most common ones is when people are newly diagnosed, they are told oftentimes by their doctors that they have to buy all new kitchen equipment or new pots, pans, I mean, thousands and thousands of dollars supplies.

00:04:18:15 - 00:04:22:23
Erin Kenny
And so a lot of times people do that, which is fine, but it isn't necessary.

00:04:23:00 - 00:04:24:10
Dr. Jaclyn Smeaton
You also need to really?

00:04:24:10 - 00:04:30:07
Erin Kenny
Yeah. You can wash it. Exactly. Yeah. And so there's just such lack of information around that.

00:04:30:09 - 00:04:49:22
Dr. Jaclyn Smeaton
Absolutely. I have celiac as well. So this has been a really great conversation. And I'm like totally thrilled to dive in with you. You can talk more about that if you want to. But before we get into the nitty gritty, I want you to start really at the beginning for our listeners, providers and patients. What is the difference between celiac disease and gluten sensitivity or intolerance?

00:04:50:00 - 00:04:55:05
Dr. Jaclyn Smeaton
And why do we have to care about that distinction. And let's just kind of lay it out. What's the difference?

00:04:55:07 - 00:05:18:23
Erin Kenny
Yeah. So celiac disease is an autoimmune disease. We can test for it. There are specific endoscopy procedures and lab work that can be done to diagnose somebody with celiac disease. Because somebody with celiac disease has an autoimmune reaction which we can test for the antibodies. And so if you are somebody with celiac disease, eating even a small amount of gluten causes an auto immune response which causes damage to small intestine.

00:05:19:01 - 00:05:42:10
Erin Kenny
And the small intestine is where we absorb so many nutrients. And so having damage the small intestine causes nutrient deficiencies, which then cause a lot of downstream issues. So definitely a big deal. And really important for somebody celiac to follow a strict, gluten free lifelong diet, whereas somebody with gluten intolerance that can be more system symptomatic of something more underlying.

00:05:42:10 - 00:05:59:02
Erin Kenny
Right. So it's something that might be resolved with treating the gut properly and addressing their health. In some cases, the symptoms might look the same for someone who's celiac and someone gluten intolerance. But the mechanism and the severity of health risks and damage are significantly different.

00:05:59:04 - 00:06:14:07
Dr. Jaclyn Smeaton
That's really important to point out. It's like the long term. Well, I actually had this come up because I got a workup. It's been a long time since my biopsy and I had to work up at a new hospital, and they were like, you don't have any nutritional deficiencies. This is pretty amazing. Let's, you know, maybe you don't actually have celiac.

00:06:14:07 - 00:06:31:05
Dr. Jaclyn Smeaton
Let's do another biopsy. And I did. But it's you know, I just I eat well, right. I'm sure you do too. But my son was like, well why would you even do the biopsy like you feel better off. It stopped. Just don't eat it again. And it's like, well, part of it is do you really have to really, really have to or is it a preference.

00:06:31:05 - 00:06:34:04
Dr. Jaclyn Smeaton
And you can, you know, eat baguettes in Paris and not have to worry about it.

00:06:34:08 - 00:06:51:18
Erin Kenny
Yeah. And there's so much misdiagnosis. Right. Like the diagnosis for celiac is really complicated from the endoscopy to the bloodwork to genetics. And so it isn't always cut and dry. And there are some instances where people need to go back for a second endoscopy to either check healing or they confirm diagnose sets that type of thing.

00:06:51:20 - 00:07:12:03
Dr. Jaclyn Smeaton
Right. Yeah, absolutely. So when a client first comes to you and they're newly diagnosed, of course this is they're in a complete state of overwhelm. Hopefully less today because I think gluten free diets are just more prevalent. And it's a lot easier to be gluten free. But what is the first thing that you want people to understand about what's actually happening within their body?

00:07:12:05 - 00:07:40:05
Erin Kenny
I think what I want people to understand at first is the beginning is the hardest and it gets easier. It's never easy. And I think initially that overwhelm is really challenging for people. And the stress that it can cause, partially from the misinformation, like I said, partially from it uproots a lot of your life, right? A lot of people think like, just go gluten free, but in packs as you know your social life, how you talk with friends and family, how you navigate your own home, the products that you used to eat.

00:07:40:06 - 00:08:03:05
Erin Kenny
And so it really changes everything. And so I want clients to know that the beginning is the hardest part. It won't always be that way. It won't always be easy. We all still have difficult days. But I think that's important because the increased stress and anxiety can cause a lot of health issues on their own. And then also explain to clients from a physical standpoint that their body is in a healing phase, right?

00:08:03:05 - 00:08:15:05
Erin Kenny
That their gut is damaged, that they are at risk for nutrient deficiencies if they don't already have them. And so being kind to their body, providing nourishing foods, supporting it, doing additional lab work, is really important.

00:08:15:07 - 00:08:29:16
Dr. Jaclyn Smeaton
Yeah. When you talk about the social impact, I mean, I think that's an understated part of the diagnosis. Like I remember talking with a patient that she was like, oh, I like brought protein bars to a wedding and like, ate them in the bathroom because I didn't want to be rude and tell the host that I had to have a special diet.

00:08:29:16 - 00:08:45:17
Dr. Jaclyn Smeaton
And it's like things like that are the ways that this intersects with your life in a way that causes tremendous stress. Yeah. You have to always kind of be prepared. Or, you know, you'll eat. Imagine the the first time you bring it up with the new friend or, you know, you know, no one wants to be a pain in the butt with how they eat.

00:08:45:19 - 00:09:04:07
Erin Kenny
Yeah. And a lot of times people are diagnosed midlife, right? Like they lived a life without celiac disease. And so you get diagnosed, and it's a quick about-face. And so it's difficult for the individual with celiac to come to terms with that, but also for the other people in their lives that they maybe went out to dinner and had pasta with them the night before.

00:09:04:09 - 00:09:10:02
Erin Kenny
And so now you're telling me I should be gluten free? I can't touch it. I can't look at it, I can't breathe it. It's really confusing.

00:09:10:04 - 00:09:29:06
Dr. Jaclyn Smeaton
Yeah, it is confusing. It's I mean, I think it's a lot. It's just a lot to take in. You wouldn't think about just avoiding food being so difficult, but because it's so prevalent, you really, really can't be. I want to talk a little bit about celiac because it's not just a gut disorder as well. We know that people with celiac disease have a wide range of other symptoms.

00:09:29:08 - 00:09:49:03
Dr. Jaclyn Smeaton
Yeah, brain fog, depression, anxiety, fatigue. I actually have had diagnosed patients who came in for infertility. And we discovered celiac on the workup or menstrual irregularity, you know, so the for many patients the burden is far beyond, just like it hurts my stomach or hurts my gut when I eat. So we talk a lot about this gut brain axis.

00:09:49:05 - 00:09:57:07
Dr. Jaclyn Smeaton
But what does it actually mean in context of celiac disease specifically? And like, why is that something that's just it's very real in celiac disease.

00:09:57:09 - 00:10:23:16
Erin Kenny
Yeah. So with celiac we know clinically there's over 200 symptoms of celiac disease. And so classic quote unquote textbook which is definitely outdated is, you know, diarrhea vomiting poor growth sometimes constipation. But we know that it can look so different for so many people. And a lot of times people are asymptomatic completely. And so what's important for people with celiac disease is getting to kind of the gut brain access.

00:10:23:21 - 00:10:40:18
Erin Kenny
So the bio directional component from our brain to our gut in people with celiac disease, a kind of an example that I tell a lot of my clients is the gut brain access works both ways. So from the brain to the gut, if you're thinking of my stomach, does my stomach hurt to that food have gluten? Did it hurt my stomach?

00:10:40:18 - 00:11:01:09
Erin Kenny
If you're thinking about that so often, you're going to get a stomach ache, right? Or you're going to have some symptoms. Same thing in the opposite way, right? A lot of, you know, our healthy neurotransmitters and, you know, like metabolic products are produced in our gut that can then go that, then go to our brain and can cause things like you mentioned, depression, mood disorders, sleep disorders.

00:11:01:11 - 00:11:23:18
Erin Kenny
And so when people with celiac disease, when a gut is damaged, that can definitely cause more cognitive issues. Oftentimes we see brain fog and fatigue. And I will say it isn't only because of celiac disease. There's obviously a million other components. And so I'm always hesitant for people with celiac disease to say I had fatigue because I had celiac, right.

00:11:24:00 - 00:11:38:00
Erin Kenny
Well, did we look at other things? Did we look at your diet. Do we look at blood sugars? Do we look at your hormones? I hate for somebody to to maybe hear what I just said of the gut brain connection with celiac, because that is important in terms of inflammation in the gut and how it impacts the brain.

00:11:38:02 - 00:11:41:12
Erin Kenny
But that isn't the only thing that could be causing it.

00:11:41:13 - 00:12:08:18
Dr. Jaclyn Smeaton
I love that you bring that up because it's like you could have celiac disease and and yeah, you know, and that's such a common, kind of assumption that we make is that, oh, everything must be related. I love that you're reminding us to go through the full workup. And we I talk about this, the perimenopause, sometimes it's like if you have fatigue in perimenopause, it could be related to hormone change, but it could be hypothyroidism or it could be an autoimmune disorder, or it could be a Epstein-Barr virus.

00:12:08:21 - 00:12:25:15
Dr. Jaclyn Smeaton
It could be a million other things. So let's not forget to put our clinician hats on and really dig in. So I mean, I'm sure that you work with people right away when they come in they may be highly symptomatic. What's the timeframe around like when you see these symptoms typically improve with a gluten free diet?

00:12:25:17 - 00:12:45:18
Erin Kenny
Yeah, it's very different for each person I would say. So in our practice we work with both pediatrics and adults. Pediatrics typically improve much faster. I worked with one this morning and at diagnosis her labs were off the charts. So over 250, which is pretty classic. We don't know if that's 251 or if that's 500 and more.

00:12:45:20 - 00:13:07:14
Erin Kenny
But within six months, she was back into a pretty standard range of 15, which is incredible. Most adults that would take longer. So it really depends on so many factors. It depends on the person's health in general. Right. Age. We have noticed a difference. Pediatrics. Definitely more heal and labs improved much faster than adults.

00:13:07:14 - 00:13:26:01
Erin Kenny
What their diet looks like, what they're doing to reduce inflammation, what they're doing to address nutrient deficiencies. And some of it's out of our control in terms of just your body's turn over time for healing. But I tell clients in terms of symptoms specifically, we should see an improvement in your symptoms in three months, six months in severe cases.

00:13:26:01 - 00:13:47:12
Erin Kenny
But what if we aren't seeing improvement in symptoms and at least improvement in labs coming down, working in the right direction? We need to dive deeper. And we do that two fold. We look at the gluten free diet. Let's daughter I's cross our T's. Let's make sure you truly are gluten free. You're not doing anything that, could get you cross contact or that's gluten sneaking in your diet.

00:13:47:12 - 00:14:03:21
Erin Kenny
And let's look at what else it is that could be causing symptoms, because maybe your gluten, free diet is working, your gut is healing, but you're still fatigued because you're not managing blood sugars, and you're eating a lot of great gluten free foods, but you're not eating enough protein. And, you know, you're getting a lot of processed foods.

00:14:03:21 - 00:14:07:13
Erin Kenny
And so that's causing fatigue and, dysregulation there.

00:14:07:15 - 00:14:22:08
Dr. Jaclyn Smeaton
You bring up I mean, there's like a couple of great points I want to talk about. I think the first one is like that commentary over eating a lot of processed foods, because I have noticed myself in with patients. One when you get diagnosed with celiac, every kind person in the universe brings you like gluten free cupcakes and brownies, right?

00:14:22:08 - 00:14:44:00
Dr. Jaclyn Smeaton
Like, but I think that you it's oftentimes you start to buy the packaged, prepared gluten free foods, because, you know, they're gluten free rather than relying on more of a whole foods diet. Yeah. And it's such a natural thing to do. But oftentimes those foods are nutritionally empty, even more so than their gluten containing counterparts, which might have whole grain wheat in them or something like that.

00:14:44:00 - 00:15:01:01
Dr. Jaclyn Smeaton
You're looking at, like rice crackers or tapioca flour, potato starches. Can you talk a little bit about that in that, like how do you help people through that? Because it's such a hard shift. But then you have these high glycemic, low nutrient foods that people are turning to. You must face this all the time.

00:15:01:03 - 00:15:25:18
Erin Kenny
All the time. Yeah. It's typical and I see it a lot when people are newly diagnosed. Like you said, you're newly diagnosed with celiac. Everyone wants you to try the newest gluten free cookie and cracker and, you know, make gluten free food for you. And when you go to the store, it's exciting because you just opened up a world of all new products, and maybe you're not familiar Trader Joe's, and you get to go to Trader Joe's and have all their great gluten free products, which is understandable, right?

00:15:25:18 - 00:15:59:01
Erin Kenny
I get from a, as somebody with celiac, you're already restricted there. So often everything is no, no, no. So when you get to say yes to a cupcake, obviously that's something that is going to be really tempting. But what's important is to make sure that the majority of your diet is still a whole food diet. Right? And oftentimes with people with celiac disease, they might have a really great diet, and then they transition to a gluten free diet and go to all processed foods, one, because they don't have the right education and support to know how to read a label and determine what canned beans are gluten free.

00:15:59:03 - 00:16:17:16
Erin Kenny
And so they say, I'll just have only canned pasta instead, right? Or they don't have the confidence to get a gluten free rice product, maybe. And so they're just going to do gluten free bread. And those packaged foods are fine every now and then. But when that becomes the bulk of your diet, that's when we have concerns, right?

00:16:17:16 - 00:16:34:02
Erin Kenny
In terms of inflammation, in terms of glycemic load, in terms of lack of nutrients, because most gluten free products aren't fortified. You know, like their counterparts. So there's a lot to it in terms of when we say a gluten free diet, it can look very different. It can be a gluten free tofu diet or gluten free processed food diet.

00:16:34:04 - 00:16:46:15
Erin Kenny
And while having a gluten free diet for somebody is the most important thing, right? And, you know, not eating wheat and those type of things, the quality of it is very quick. Second important.

00:16:46:17 - 00:16:53:04
Dr. Jaclyn Smeaton
Do you have any quick hitting suggestions of like these are some of the top nutrient dense, gluten free foods I steer by my clients to?

00:16:53:06 - 00:17:11:07
Erin Kenny
Yeah, I release a Whole foods. I mean, you still should be eating fruits and vegetables and meats and potatoes and rice like it doesn't. The basic things that don't have a gluten free label that are only a few ingredients, and I think a lot of people get concerned because even something like a can of beans might not be gluten free.

00:17:11:09 - 00:17:15:22
Erin Kenny
But if ingredients are just baked beans, water and salt, that's a great food product.

00:17:16:00 - 00:17:16:11
Dr. Jaclyn Smeaton


00:17:16:14 - 00:17:38:00
Erin Kenny
Right. And so having my role and something I take really seriously, supporting the education to people so that they can pick up any product they don't need to rely on a food scanner or, you know, googling everything to determine is this safe or not. Because most whole foods don't have a gluten free label, you're not going to pick up a water bottle that says gluten free.

00:17:38:02 - 00:18:02:03
Dr. Jaclyn Smeaton
But the other thing that you'd mentioned is around, like the time it can take to heal. Yeah. And also contamination. And I'm curious about your experience. Where have you found that some people, they are, less reactive to contamination, whereas other people, like they even need their own toaster in their house because like, the crumbs from the gluten toast will get on theirs and they'll get sick from it.

00:18:02:03 - 00:18:09:03
Dr. Jaclyn Smeaton
Like, from a lab perspective or a clinical perspective, is there variability in that reactivity?

00:18:09:05 - 00:18:28:19
Erin Kenny
Good question. So a few points. Yes, there is variability in the reactivity or the symptoms that someone would experience, but that doesn't relate to the amount of damage. Right. So there are some information misinformation I'm going to say online that says people have different severities of celiac disease, which isn't the case. Right? You're they're pregnant or you're not pregnant.

00:18:28:19 - 00:18:31:22
Erin Kenny
You have celiac. You don't have celiac disease, right? You might have.

00:18:31:22 - 00:18:32:21
Dr. Jaclyn Smeaton
Been pregnant.

00:18:32:21 - 00:18:36:04
Erin Kenny
And you can't tell me how pregnant. Know, you might have a tougher pregnancy.

00:18:36:05 - 00:18:38:17
Dr. Jaclyn Smeaton
You might get a little pregnant, just not healthy.

00:18:38:19 - 00:18:39:20
Erin Kenny


00:18:39:22 - 00:18:45:08
Dr. Jaclyn Smeaton
I'm not pregnant, by the way. Let's not let that get out. Yeah, I thought of that.

00:18:45:10 - 00:19:07:05
Erin Kenny
And so that is kind of the, like the misnomer around your symptoms equate to how how strict you need to be or how much damage it's causing. So symptoms don't necessarily matter in terms of strictness. Everybody, whether you have symptoms or not, need to follow a strict gluten free diet. There's actually some research on the toaster.

00:19:07:07 - 00:19:27:12
Erin Kenny
In, kind of comment that there is some good research that shows that even sharing a toaster can cause enough cross contact to expose somebody to gluten. And so most people aren't gonna get sick from that. It's not the enough level to get sick, but there is a higher risk of gluten there. And so having separate toasters is typically a recommendation that we make for most people.

00:19:27:14 - 00:19:42:20
Dr. Jaclyn Smeaton
I feel like you probably need to say that a lot of other people in the back or that come to like, symptoms don't tell you how much you're reacting, because I'm guilty of that, too. Like, when I travel internationally, like sometimes I'll splurge on a food and eat it because, yeah, tastes good. I don't find I react as much physically.

00:19:42:23 - 00:19:57:13
Dr. Jaclyn Smeaton
I don't get the same symptoms from, you know, even flowers and stuff like that overseas compared to here. But okay, it's a good reminder to like rein it in for all of you listening are in the same boat where you like to kind of once in a while splurge probably on the best idea.

00:19:57:15 - 00:20:05:05
Erin Kenny
I mean, there's plenty of people that are fully asymptomatic that we have worked with, and if they don't follow a gluten free diet, your labs are not going to look great, right?

00:20:05:09 - 00:20:12:18
Dr. Jaclyn Smeaton
And then the long term, tell us, like, what's the long term impact of that? Like though these long term risks of celiac, which is why we care about staying away. Yeah.

00:20:12:20 - 00:20:34:22
Erin Kenny
So first most of the issues that happen with celiac are due to nutrient deficiencies and the inflammation that occurs in the gut okay. And so common nutrient deficiencies B12, iron vitamin D when those are depleted because they're not absorbed properly. We notice a lot of downstream effects right. So that can be neurological issues from B12. It can be hormonal issues.

00:20:34:22 - 00:20:57:23
Erin Kenny
It can be infertility is really common right. Celiac does it cause infertility directly? It's the nutrient deficiencies that are caused by an untreated celiac that can cause infertility. There are some research, that cites that there is some cancers that are increased risk for people with celiac disease. But I always say that these risks are not for everybody with celiac.

00:20:57:23 - 00:21:16:11
Erin Kenny
They're for people with celiac that don't follow a strict gluten free diet. So if you are following a strict gluten free diet, these risks diminish significantly right there. Plenty of people, myself included, that have gone on to have healthy, beautiful pregnancies without fertility issues once they follow and manage a gluten free diet as an example.

00:21:16:13 - 00:21:21:23
Dr. Jaclyn Smeaton
That's a great reassurance. We'll be right back with more.

00:21:22:01 - 00:21:49:18
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00:21:58:06 - 00:22:16:14
Dr. Jaclyn Smeaton
So you talked about the damage in the gut. And I think, you know we think about that a lot because inflammation in the gut and damage to the villi and you know the inflammation and intestinal intestinal permeability that can come up which we call like leaky gut sometimes these can really factor into the symptom pictures for patients.

00:22:16:14 - 00:22:31:03
Dr. Jaclyn Smeaton
Even when we talk about neurological impacts and neurological symptoms. Can you share a little bit about the connection there? And I know intestinal permeability can be an issue for people who don't have celiac, but is it a bigger issue for people who do?

00:22:31:05 - 00:22:53:17
Erin Kenny
Yeah. Good point. I think it's important to have people understand that a lot of these issues happen in people thought celiac, right. Hormonal issues, infertility happens in people without celiac. Right. So just because there's infertility doesn't mean that that person has you that and just because somebody I see that doesn't mean they're going to have infertility or or, hyper permeability, leaky gut with leaky gut.

00:22:53:17 - 00:23:16:16
Erin Kenny
We have seen it more commonly in people with celiac. Right. We're going to see more inflammation in the gut in general. Right. Because celiac damages the small intestines. It creates more inflammation there. And other factors too. Right. Stress is really important. Stress is a big factor for gut health. And we know that a lot of people with celiac disease have higher stress, especially around food, especially around eating.

00:23:16:22 - 00:23:47:02
Erin Kenny
And so that impacts our gut health. You know, other factors like their food intake. We talked about food quality in a gluten free diet that can impact their gut health. And so there isn't research to say that people with celiac disease have a higher risk of leaky gut, right? I don't want to say that I have seen in our clinic there is a higher chance of people with celiac disease having leaky gut than the standard population, but not significantly because many, many people have leaky gut as well.

00:23:47:04 - 00:24:10:15
Dr. Jaclyn Smeaton
Yeah, that's really fascinating. So when you are seeing that, I mean, obviously this can have an impact longer term. And we know that, dysbiosis and digestive problems actually are a root cause for autoimmunity. So it seems like there's this vicious cat chasing its tail kind of mechanism happening there where, you know, if you have this gut damage, you could be more predisposed to autoimmunity.

00:24:10:18 - 00:24:15:08
Dr. Jaclyn Smeaton
Yeah. And when you have this celiac autoimmunity, it's making your gut even worse.

00:24:15:10 - 00:24:31:22
Erin Kenny
Yeah. Yeah. And that's tricky Barton. And we often see autoimmunity come in pairs. And so one of the mechanisms is throughout health but with celiac because it impacts your gut. So specifically on a mechanics mechanistic level, that also kind of increases, you know, the risk of autoimmunity.

00:24:32:00 - 00:24:34:07
Dr. Jaclyn Smeaton
Do you see a lot of dysbiosis as well?

00:24:34:09 - 00:24:54:05
Erin Kenny
Yeah, definitely. Yeah. One of the when people come to us is celiac. One thing that our clinic really specializes in is people that have celiac. They have gone gluten free for at least six months. Right. Often we'll see people years out and they're still having the same GI issues, if not worse than before they went gluten free. And so oftentimes people will double down on the gluten free diet.

00:24:54:07 - 00:25:13:08
Erin Kenny
I need to be more gluten free. Any gluten free tampons? I need to burn my kitchen now like you don't. I mean, I can't eat out all those types of things, right? And they still feel sick. And so we need to come in and say, well, we have to look somewhere else. And so we'll use additional testing. The DUTCH test, the stool test, to figure out what is the root cause of this person's symptoms.

00:25:13:08 - 00:25:23:07
Erin Kenny
And oftentimes it can be US biases. So bacterial overgrowth we'll see Sibo really often. And treating those things can be significant for people. Synapses.

00:25:23:11 - 00:25:43:02
Dr. Jaclyn Smeaton
Yeah I imagine because I mean that. Right. We know that microbes are so critical for you just for food digestion and breakdown of so, so important that they're in good shape and healthy and happy and they don't survive well and and inflamed. Got a lot of times you even see, dysbiosis where there's a lack of organisms. You actually just don't have enough organisms to kind of protect your gut.

00:25:43:04 - 00:25:46:00
Dr. Jaclyn Smeaton
And that happens quite a lot in those states of chronic inflammation.

00:25:46:01 - 00:26:13:02
Erin Kenny
And it's tricky because those people that have dysbiosis have bacterial overgrowth, have inflammation. Anytime they eat something, they have a stomachache. And so in their mind, if they aren't thinking of dysbiosis and like gut inflammation, which most people aren't, they're thinking that I got gluten every time I eat. And so that's really tricky because now they want to be more strict and more strict, and they have a a bad feedback loop of thinking that they're constantly getting gluten when really gluten isn't the issue.

00:26:13:05 - 00:26:34:15
Erin Kenny
Yes, you need to still be gluten free, but we have to address this other issue. And oftentimes with our clients, when we address things like, you know, supporting their gut health, leaky gut, reducing their immune response, supporting bacterial overgrowth, they can now eat a regular gluten free diet. Right? Right. And not every single food causes issues, which gives them a lot more gluten free freedom per se.

00:26:34:17 - 00:26:58:16
Dr. Jaclyn Smeaton
Yeah, it's interesting because I think there's I mean, anyone any clinician who's worked with patients with gut issues, you really get a very strong sense of the level of distress. Yeah. That you connect eating food, which should be a nourishing process with because it's, you know, you're always afraid. Afraid of the food, afraid of the food causing you pain, causing you symptoms, causing you gas and bloating, whatever that symptom is.

00:26:58:18 - 00:27:22:22
Dr. Jaclyn Smeaton
I mean, I know patients who had put themselves on such a restricted diet or just would like, really hesitate to eat at all because they just knew they were going to feel bad and that, like you had mentioned before, that perpetuates the cycle. Both the story you have about the food, right, about eating, but then also the stress and the fact that your gut, you know, you require parasympathetic nervous innervation for digestion to happen.

00:27:23:00 - 00:27:42:21
Dr. Jaclyn Smeaton
Maybe you can talk a bit more about that, cause I think that's a really good shift into DUTCH testing, actually, with cortisol, about just the importance of like what emotional state and physiological state we really need to be in to optimize digestion, and that's for everybody. But if you have a celiac or you have any kind of digestive challenges, it's even more so.

00:27:42:23 - 00:28:03:16
Erin Kenny
Yeah. Yeah. I love this, topic and I think we see it. Celiac is a really good example of this, but it can happen to anybody, right? Yeah. And so with, with oftentimes our clients with celiac disease when they're newly diagnosed and they're figuring out this gluten thing, you go to a restaurant, you ask the right questions, right?

00:28:03:16 - 00:28:15:07
Erin Kenny
And hopefully get a good gluten free meal, right? You order enchiladas and you're like, I'm going to hope that this is celiac safe, but you're so really nervous, right? Because you don't know if you ask the right questions, you don't know what the chefs understood you. You don't know what they do in the back. You don't know. You don't know.

00:28:15:10 - 00:28:32:10
Erin Kenny
Right. And so you're really nervous eating this food and maybe a family member made a funny comment to you and that kind of made you extra stressed. And so now you're at this restaurant eating in a stress state. Your body isn't in that parasympathetic rest and digest state. And so it's going to be harder for you to eat.

00:28:32:12 - 00:28:46:07
Erin Kenny
And so you eat your meal, right. It's not digesting properly. You might start to feel a little bit, bloated, need some acid reflux. If it's just kind of sitting there and then after the meal, you start to feel it sitting there and you're like, well, that feels a little funny. I'm not used to that was I just couldn't.

00:28:46:09 - 00:29:00:16
Erin Kenny
And then add that to that gut brain, you know, connection was I just gluten, was I sick? What questions did I met up? How did I do this to myself, you know. Oh, now my Uncle John was right. I'm going to get sick anyways, you know, where's the bathroom? Am I going to make it to the bathroom on time?

00:29:00:18 - 00:29:18:15
Erin Kenny
You know, is this going to damage my lab results? All of those kind of things have a story. You tell yourself how you're interacting with your food. Can be such a vicious cycle. And we make things really challenging for people with celiac that even if you're eating gluten free meal, you're still going to get symptoms if you aren't in the right psychological state.

00:29:18:15 - 00:29:19:20
Erin Kenny
Going into it.

00:29:19:22 - 00:29:41:06
Dr. Jaclyn Smeaton
I have to just point out I love that you're saying, have I been gluten because I've never heard that before. You've like, made it a verb, like have I? Oh yeah. I'm like hit with hit. You know, if I buy gluten, I love that. And I'm taking it with me. That's really fun. Yeah. So when we talk about nutritional deficiencies, are there nutrients that you just are almost always replenishing in celiac patients.

00:29:41:08 - 00:29:45:00
Dr. Jaclyn Smeaton
And how do you know when you can actually start that when they're like ready to be absorbed.

00:29:45:02 - 00:30:09:07
Erin Kenny
Yeah. So I would say in celiac and not celiac when we're looking at the gut health picture, oftentimes we're seeing iron deficiencies vitamin D and magnesium. So I'll oftentimes we're supplementing with those. But we also want to get live. So typically if somebody comes to us newly diagnosed or if they're having symptoms in line with nutrient deficiencies, we're going to get labs most commonly a celiac picture.

00:30:09:07 - 00:30:18:08
Erin Kenny
It's going to be iron, B12 and vitamin D, sometimes full weight and some some additional vitamins. But those are probably the most common ones that we'll see.

00:30:18:10 - 00:30:32:09
Dr. Jaclyn Smeaton
Okay. And the other one I want you to talk about is tryptophan. Like tryptophan. That's interesting because tryptophan seems to come up a lot in the research as like a big piece of the mood puzzle for celiac patients. Can you talk a little bit about that. And like a really simple explanation for us.

00:30:32:11 - 00:30:57:16
Erin Kenny
Yeah. So tryptophan is what helps us make serotonin right. We all want serotonin. And so serotonin and tryptophan can be blocked when the intestines are damaged from celiac disease. And so one mechanism there's a few. But to simplify it one mechanism is if we can't absorb the serotonin tryptophan properly, we're not going to get this happy mood boosting chemicals which can cause mood disorders in people with celiac disease.

00:30:57:18 - 00:31:14:14
Dr. Jaclyn Smeaton
Thank you for clearing that up. Yeah. Now I do want to shift and talk a little bit more about DUTCH testing, because I love that you're using those testing where you think like, oh, celiac, we should be thinking about gut testing, right? So I love that we're going to have the chance to talk a little about the role that testing plays in your practice.

00:31:14:16 - 00:31:32:21
Dr. Jaclyn Smeaton
And I think a lot of it starts with the fact that celiac is a physiological stressor for the body. And we talk about this a lot with patients and even with clinicians who are newer to looking at the HPA axis, because when we think about stress, we naturally think about emotional stressors. And of course, with celiac, we talked about that.

00:31:32:21 - 00:32:00:00
Dr. Jaclyn Smeaton
There's emotional stressors too. But sometimes when someone doesn't perceive themselves as being stressed in their day to day life, they have raging cortisol that can be due to a physiological stressor. So some of the ones that we talk about often are a blood sugar dysregulation, chronic inflammation, pain or injury. We had this one report just has a little side interest, where we always look at the reports that are out that are like out of the norm.

00:32:00:00 - 00:32:20:02
Dr. Jaclyn Smeaton
Our doctor team reviews them before we release them to the doctors, to our ordering clinicians. And there was this one where it looked like a contamination. The cortisol was like sky high, but the cortisone was also sky high, which usually was contamination. You only see cortisol go up and we're like, oh, this is so interesting. This really is this incredible elevation midday.

00:32:20:04 - 00:32:38:13
Dr. Jaclyn Smeaton
And then so we ended up phoning the provider to try to say, can you try to find out from your patient what happened. This test is really unusual. Well they broke their arm mid day. They like had a bicycle accident broke their arm. And then God bless them they finished their test sample collection even after like leaving the air with a cast.

00:32:38:15 - 00:33:01:01
Dr. Jaclyn Smeaton
And that's what we saw. So like that physical injury, tissue injury all of those things drive cortisol just like emotional stress. Our body really can't tell the difference. So yeah, back to celiac. You have this like prolonged period of physiological stress over time. So I'd love to know what you think about like how when you should be ordering digest for patients with celiac.

00:33:01:06 - 00:33:03:13
Dr. Jaclyn Smeaton
What are the first things that you look at.

00:33:03:15 - 00:33:22:01
Erin Kenny
Yeah good question. So I think kind of tying back to you can have celiac and something else. Right. So when a client comes to us and they're following gluten free diet and we do our due diligence, we yes. John Smith you're on a, you know, you're on a gluten free diet and you're still having issues. We want to find the root cause.

00:33:22:01 - 00:33:42:01
Erin Kenny
We want deeper. We want to get more data. And so the DUTCH test is really the best way for us to get a good picture of their stress response from cortisol, as well as their hormone needs. And cortisol is interesting because like you said, you can tell a, you know, tell a patient, hey, I'm really seeing a lot of different increased stress responses here.

00:33:42:03 - 00:34:05:08
Erin Kenny
And every time I'm not stressed, I feel great. Right? But having them understand and the DUTCH house is really helpful for this because I can show them paperwork and lab data. To say this shows your stress response. You might not feel it, but your body is feeling it and your body is telling you that you are overstressed. And so that can be really, really helpful for clients to see the data, right?

00:34:05:11 - 00:34:26:17
Erin Kenny
Because they think stress is just in their brain. And with celiac disease, it stresses out your body from nutrient depletion, from stress response, from eating challenges, a multitude of different things. So the DUTCH shell is helpful in the picture of somebody is a high stress state, and we want to be able to show that to them and get them some data that's really helpful to get their buy in for treatment.

00:34:26:18 - 00:34:34:03
Erin Kenny
And, helping us paint a better picture when, you know, we suspect that hormones are in the picture.

00:34:34:05 - 00:34:54:12
Dr. Jaclyn Smeaton
I love that you talked about it as like a buy in mechanism. I think that's such a great descriptor. I mean, some people come into you saying, I'm so fatigued, I'm so overwhelmed. I'm anxious, I'm stressed. I like need some help with this. But there's a whole group of people that are doing a lot. I'm like, the arrows are like pointing to me at night right now.

00:34:54:13 - 00:35:13:18
Dr. Jaclyn Smeaton
You do a lot, you carry a lot. You feel resilient and you feel like you can handle it. And so maybe someone else with your load might feel stress, but you're like, no, I've got this. Like, I've got all the balls in the air. Everything's still floating. We're all good, right? So but those people, we need to see it on paper to make us say like, oh, oh, wait a second, maybe I need to actually stop.

00:35:13:22 - 00:35:37:01
Erin Kenny
Yeah, yeah. And to that buy in and typically, again, this is very, stereotypical. But again, I'll put arrows up myself to the people that are often have a bunch of balls in the air. One data. Right. They want to see something on paper. It's somewhat that same personality type in some instances. And so that's helpful to get that buy in, whether it's from the cortisol picture or the hormone picture.

00:35:37:03 - 00:35:38:17
Erin Kenny
It can be really helpful.

00:35:38:18 - 00:35:55:01
Dr. Jaclyn Smeaton
See we like to have that. Like we like to have the data because then we can out compete ourselves to like show how we can improve over time. It like it serves our little Type-A personalities, right? Yeah. Well, I want to talk a little bit more about the HIPAA access to what do you typically see for cortisol on your celiac patients?

00:35:55:01 - 00:35:58:08
Dr. Jaclyn Smeaton
Are there patterns that tend to come up more often?

00:35:58:10 - 00:36:31:09
Erin Kenny
I honestly wouldn't say there's a significant pattern related to celiac disease when it comes to the HPA cortisol. But I would say in our general client that we see, which is somebody that typically has a history of health issues, right? They come to us with really complex cases that doctors haven't been able to solve and to figure out, and they're typically in a higher stress state a lot of times because of the complex health issues, because of the weight that they carry from having to manage celiac disease and these other potentially autoimmune conditions.

00:36:31:09 - 00:36:55:10
Erin Kenny
And so we see cortisol disruption, but significant majority of the time, I would say at least 80% of the time. And so that's one of the major things that we work on with clients and help educate clients on of how we can reduce cortisol. Obviously, there's supplements that are helpful, but just lifestyle things. Right? And it's different for each person in terms of what could be contributing to their cortisol dysregulation.

00:36:55:12 - 00:37:17:17
Erin Kenny
But even things like what is your sleep hygiene? Right. Are you a busy mom that's like puts the kids to bed and now you're just scrolling at night for a few hours because that's relaxing to you. But maybe that isn't helping. You know, your cortisol and your sleep patterns and that type of stuff. And so we really focus on the lifestyle piece as well, so that the person can carry those habits with them way beyond, you know, our, our support.

00:37:17:19 - 00:37:42:21
Dr. Jaclyn Smeaton
I mean, that sounds like it's so important. It's more than just food that you put in your body. There's all these behaviors that you need to put into place for really to support optimum healing. Yeah. Now another element of the DUTCH that's I can imagine will be helpful when you're discerning the like celiac related symptoms from others is that we have a lot of neurotransmitter evaluation in our organic acids like you know hva VA chyme urinate kundalini.

00:37:43:00 - 00:37:48:00
Dr. Jaclyn Smeaton
Are those things that you look at as well. And do you see them change? Typically?

00:37:48:02 - 00:38:20:18
Erin Kenny
Yeah. I mean we're the doctors is great because it shows us so many different markers that we can look at. And if we're going to work with the DUTCH that's on somebody, it's because we suspect some underlying issue. Right? This isn't just we throw it out for everybody with, with the celiac. Not that we think that test is needed, but it can be helpful to, to show and again, kind of like point to maybe a root cause of why there is mood disorders, why there could be related to fatigue where there could be some dis really regulation on that gut brain axis, and why it's also important that we're always tying gut health into

00:38:20:18 - 00:38:42:05
Erin Kenny
things with hormones, right. With hormones, with neurotransmitters. And explaining that connection to the clients, because you and I talk about the gut brain access, second nature. But it's such a weird concept for people to think of the gut and the brain being connected. I mean, if you told me that, like, my fingertips and my eyeball were connected, I'd be like, what?

00:38:42:07 - 00:38:58:10
Erin Kenny
And so it's kind of communicating the same thing to the client of saying this lab results, you know, on your lab test of showing your neurotransmitters is important. We need to address this. And it also relates to your gut. And improving your gut health and improving your diet is all really tied together.

00:38:58:12 - 00:39:15:15
Dr. Jaclyn Smeaton
Yeah, it's so interesting. I mean, we make so many neurotransmitters in our gut that a lot of people say the gut is the second brain. In that way. And all those neurotransmitters don't make it to the brain to have activity the way they great ones that are made in the brain do. But there is obviously a huge connection with these neurotransmitters and gut health.

00:39:15:15 - 00:39:39:11
Dr. Jaclyn Smeaton
And then you look at now this new information on microbiota and their influence on mood and health. And I mean, there's just so much we don't know right now. But a good a good guess is make sure you have good digestion. Just a good foundational guess. Yeah. To be really working on that. Yeah. Well I want to talk a little bit more about how you're managing and helping people.

00:39:39:11 - 00:40:04:16
Dr. Jaclyn Smeaton
I'm sure that's why everyone's listening. They want to know, like, okay, this is all great, but what can I actually do about it? So the gluten free diet is obviously the foundation of the care that you're providing. Yeah. But when you have patients who have symptoms like maybe anxiety and depression that are persistent, even when they're gluten free and, you know, there's inflammation and chronic stress physiology going on, you know, really you need to do more than just diet alone.

00:40:04:16 - 00:40:13:03
Dr. Jaclyn Smeaton
You need that nutrient rehabilitation, nervous system rehabilitation, sleep rehabilitation. So where do you start with most patients.

00:40:13:05 - 00:40:40:20
Erin Kenny
Yeah. Yeah. So with anxiety and depression which is pretty common in the general population. Also with celiac, you know we always want to tie in other providers. You know therapists that can be helpful as well. Obviously diet is important. Nutrients is important. But I think when it comes to celiac specifically, one thing that we do differently is as providers that have celiac, we understand the emotional component, and celiac itself can be very, very isolating.

00:40:40:22 - 00:40:59:12
Erin Kenny
And the patients and the clients that come work with us oftentimes that are the sickest are not the sickest physically. That part's easy, right? I can we can fix you physically. It's the emotional and the mental part that is really challenging when somebody is really isolated because they don't ever eat out, right? They don't ever go to friends events.

00:40:59:12 - 00:41:24:16
Erin Kenny
They don't want to do potlucks. They don't have people in their own home. They're nervous every time they eat it. It it. Celiac can take over somebody's entire life. And so when that happens, that can be a big contributing factor to anxiety and depression, right? Anxiety around food, anxiety around people inside your on those conversations. And so really supporting our, our clients in that and helping them understand what is a risk and what isn't right.

00:41:24:18 - 00:41:59:13
Erin Kenny
Can you go to somebody else's house and use their kitchen supplies? Yes. Just make sure it's washed right. But for them, they need to have the confidence that someone they're getting the information from is educated and trained and they can trust. And so that's really what we bring to our clients. So when we're seeing those type of mood disorders, helping the client understand how we can integrate celiac into their life without letting it take over their full life, because when it comes so overwhelming, so encompassing, so isolating, we can see a lot of mood disorders caused really by celiac disease.

00:41:59:15 - 00:42:27:13
Dr. Jaclyn Smeaton
That's such an interesting point. So just to kind of reframe is make sure I've got it. What you're seeing is almost a secondary mood disorder, not because of the biology of celiac, but because of the social impact of celiac. Correct? Yeah. That's wild to really think about the layers of this, but it absolutely seems like that really important cause and effect that you're doing through preventive medicine, by really helping people figure out how they can maintain the connections with people that leave them in good health.

00:42:27:15 - 00:42:47:17
Erin Kenny
Yeah. And I mean, if somebody has anxiety around eating and being social, yeah, they could take medication for it. Yeah. We can help their gut health to, you know, improve it. But if they don't have the skills to go out to a restaurant and order food, they're still going to be stuck isolated. So we need to give them the skills and the encouragement to go out to a restaurant and order food.

00:42:47:18 - 00:42:51:11
Erin Kenny
And almost like exposure therapy in some instances.

00:42:51:12 - 00:43:08:16
Dr. Jaclyn Smeaton
Yeah. Now the other piece that I you've talked about is that nervous system regulation. And we talk about that a lot, but like, how do you bring that into a conversation with a celiac patient when maybe they don't have this best? I mean, I think about the people who come to see a natural pathway, doctor, they know what they're going to get.

00:43:08:16 - 00:43:20:07
Dr. Jaclyn Smeaton
But with you, with your diet dietitian background, nutrition background, you're probably getting more diversity. How do you bring this in and start the conversation rolling with those patients that maybe haven't thought about this before?

00:43:20:09 - 00:43:41:07
Erin Kenny
Yeah, we see this a lot. We see this when we a client comes to us with gut health and they're like, I have celiac disease and bloating. Help me with my bloating from celiac. And we have to have the conversation up. Actually, it really sounds like this bloating is more hormonal focused, right? Or actually it seems like this is more a stress response or you know, this is a nervous system dysregulation thing.

00:43:41:07 - 00:44:11:14
Erin Kenny
And so it's pretty common. And I think it involves multiple conversations. It's rare that you're going to tell a client once, hey, I think your stress response is just regulated. Hey, I think nervous system is an important factor. Let's try meditating. And then they're just going to now be a medic. You meditation. Right. It takes a lot of education and resources and figuring out for the specific client what tools, what resources work for them while it's clicking in their brain that that's a factor.

00:44:11:19 - 00:44:28:10
Erin Kenny
And until it clicks, because sometimes the client needs to take the leap of faith and trust us, which takes time to build trust with our clients. To understand that, you know, the nervous system regulation is a big piece of that same thing with the gut. Health is a big piece of it. Hormones is a big piece of it.

00:44:28:10 - 00:44:33:22
Erin Kenny
Thyroid can be a piece of it. It isn't always just my gluten free diet is going to fix everything.

00:44:34:00 - 00:44:47:04
Dr. Jaclyn Smeaton
Yeah, I think that's really, really important to be thinking about when it comes to eating. Do you incorporate any kind of tips around eating as well to like serve that nervous system dysregulation?

00:44:47:06 - 00:45:06:11
Erin Kenny
A lot of especially with our gut health, you know, clients that really struggle with poor gut health is the rest and digest mindset, right? We're not eating in a quick state. We're not eating in front of the TV or in front of our phone. We're really chewing our food. Well, putting them in, a parasympathetic state can be really helpful to support the nervous system.

00:45:06:13 - 00:45:18:01
Erin Kenny
And then we can do other things outside of the eating window in terms of getting outside in the morning sunshine, taking a walk, doing other things to kind of support nervous system, you know, minerals and that type of stuff too.

00:45:18:03 - 00:45:33:13
Dr. Jaclyn Smeaton
It's cool. I mean, I think there's so much you can do, like at the table. Yeah. What I love that suggestion of like, don't be doing other things. I used to tell my patients, like eating is the activity. It's the price. Like it is the only thing you should be doing. Not I'm eating. And if you're adding an end, you need to stop that thing.

00:45:33:13 - 00:45:48:02
Dr. Jaclyn Smeaton
And, like, just eat. This is, you know, you guys can't listen. But this is me saying this, but I was like, shoving my face with lunch while Aaron was like, you know, rejiggering our camera. So we don't always get it perfect, but we have to try our best whenever we can. So, you know, but we do our best with that.

00:45:48:02 - 00:46:10:09
Dr. Jaclyn Smeaton
And the other thing that I always loved doing is having people just take like breaths, like breathe between your food, take a bite, chew it until it's like a, you know, liquidy mush consistency. You don't swallow your food whole, which actually helps digestion. It makes it way easier. People forget the mouth is the start of the gut. And then I think, just like pausing and taking a deep breath before your next meal, like next bite.

00:46:10:09 - 00:46:21:09
Dr. Jaclyn Smeaton
I just think those really simple tips, when you start to do them and you realize how hard it is, then you realize how much you are not following those things. When you're trying to eat. Most of us eat in a rush.

00:46:21:15 - 00:46:26:03
Erin Kenny
Especially if you tell people, hey, make sure you're chewing your food. No one thinks they don't chew their food, right?

00:46:26:03 - 00:46:26:23
Dr. Jaclyn Smeaton
Or like.

00:46:27:01 - 00:46:30:06
Erin Kenny
Stick to their food, you know? No, but they don't.

00:46:30:07 - 00:46:42:13
Dr. Jaclyn Smeaton
Know you don't. And until you start to think about it, you're like, oh, wow. Yeah, I really did. Like I swallowed that let us hold or that whatever that is. Like you only to eat enough to get it down. Not enough that it's like a consistency that it should be.

00:46:42:18 - 00:46:59:03
Erin Kenny
Yeah, yeah, yeah. It's actually when we get clients that, you know, we talk about stool undigested particles in their stool. Right. Clearly you're not chewing your food. Right. So last week we talked about you were chewing your food. And this week we've had this conversation about what's in your stool. And so chewing your food is going to be important, you know, a goal for this time.

00:46:59:03 - 00:47:14:17
Dr. Jaclyn Smeaton
So I know thank goodness for a hormone podcast. When I was doing lung cancer, we'd be talking about that stuff all the time. But you're totally right. If you see corn or tomatoes or whatever, you can tell what you ate based upon looking at your stool. You got to start at the beginning. You got to to your food because you should have taken care of that when it was under your control.

00:47:14:22 - 00:47:36:20
Dr. Jaclyn Smeaton
Absolutely. Yep. I love that suggestion. So I mean, this has been awesome. We've I've learned a lot and really gained from speaking with you. I know we have a lot of providers and a lot of patients listening. So I want to start by what you would say to a listener today who was maybe diagnosed with celiac disease. They are through that initial phase.

00:47:36:20 - 00:47:45:08
Dr. Jaclyn Smeaton
They feel like they're doing everything right, but they're just not feeling like themselves. What would be your suggestions for them on what they should do next?

00:47:45:10 - 00:48:04:06
Erin Kenny
Yeah. Good question. If for anybody with celiac you've been gluten free for six months, 3 to 6 months and you're still not feeling well, whether symptoms change, whether they're the same, whether they got worse, whether they got a little bit better, or if you are not feeling normal, you're not feeling well. It's time to look at something else.

00:48:04:08 - 00:48:29:18
Erin Kenny
Go to a provider that understands gluten free, that understands your celiac needs so that they can treat you through a gluten free lens, but that they can also look at other things with a really functional, holistic approach that they can understand gut health and hormones and thyroid and other pieces that are important equation to your health. And then for providers on the same thing, if somebody comes to a celiac and they're still having got issues, don't just assume it's because they're not properly following a gluten free diet, right?

00:48:29:18 - 00:48:53:11
Erin Kenny
Because they might be following a perfectly gluten free diet and focusing too much on the gluten piece, you could miss an entire picture of what else is going on. And so I think that that is kind of like my biggest recommendation for both providers of what we're looking at when managing somebody with slack and then for people with celiac is that you should if you're following a gluten free diet, live a happy, healthy life with eating gluten free and not having symptoms.

00:48:53:11 - 00:49:00:10
Erin Kenny
Right? Just because you have select disease doesn't mean you have to live a life with symptoms. You can be symptom free if you are not, you need to explore further.

00:49:00:12 - 00:49:20:11
Dr. Jaclyn Smeaton
I love that, I mean, and I we can't get you off the podcast without asking you one final question, which is what are your favorite gluten free splurges and foods? I mean, I think that was one thing that was actually super hard when you first get diagnosed is you want to try everything and you waste so much money on these, like expensive foods that you try and you're like, oh my gosh, I can't even possibly these crackers.

00:49:20:13 - 00:49:30:06
Dr. Jaclyn Smeaton
Yeah. So what are your favorite gluten free go tos that are your bread and butter every day. And then maybe like on that processed made treat kind of side. What do you go to.

00:49:30:08 - 00:49:53:02
Erin Kenny
Yeah. Every day I really love a good bread from a local bakery. I don't have a specific local bakery in mind, but I do find that local bakeries have better gluten free bread products than a lot of the big box names. So anytime I get to a local bakery, that's always like a good splurge. Capello's also makes the best, biscuits.

00:49:53:04 - 00:50:13:09
Erin Kenny
So those are one of my favorites. Pasta. Nowadays, pasta is pretty good. I've been gluten free for over a decade, and so honestly, I'm just amazed every time I eat a gluten free product how I partially my tastes have changed. I haven't had regular gluten in, you know, many years, but all the products now, compared to how they were 10 or 15 years.

00:50:13:09 - 00:50:14:13
Dr. Jaclyn Smeaton
Ago, there's so much better.

00:50:14:13 - 00:50:15:08
Erin Kenny
Oh, much better.

00:50:15:13 - 00:50:21:11
Dr. Jaclyn Smeaton
So I was just be like this gummy pile of like, sticky rice. Yeah, yeah, so much better.

00:50:21:12 - 00:50:26:21
Erin Kenny
There's so much about it like that. You can basically make anything gluten free now, which I'm grateful for every day.

00:50:26:23 - 00:50:34:02
Dr. Jaclyn Smeaton
So yeah, I actually like when I make gluten free pasta, I'll be like, gosh, this is so good. You can't even tell the difference of my kids are like, yeah, you can. Yeah.

00:50:34:04 - 00:50:38:14
Erin Kenny
I know for me, I like my taste like change. The products change. I don't know, but I'm happy with it.

00:50:38:16 - 00:50:55:15
Dr. Jaclyn Smeaton
Right? They don't complain. They still eat it. So that's good. Yeah. The breads there's I'm in New England and there's a bakery in New Hampshire called Abigail's. I'll do like a little shout out to them, because they make a millet and sweet brown rice bread. That is the best texture. It's so good. And they even make a cinnamon roll like a cinnamon swirl bread like that.

00:50:55:15 - 00:51:15:20
Dr. Jaclyn Smeaton
It is so good. They are very yummy. But I completely second that. If you can find a local bakery that's gluten free. Seattle had some great bakeries. Yes. Yeah. When I lived out there that were gluten free, that were amazing. Yeah. Well, I really appreciate you coming on today to share with us all that you've learned. And I mean, those takeaways I think are so important of, you know, managing the celiac.

00:51:15:20 - 00:51:30:06
Dr. Jaclyn Smeaton
But also thinking outside the box because it's not always just that good. You have to be able to look elsewhere if you're not getting where you think you need to as a patient or as a provider with your patients and clients. So Erin, thank you so much for joining me. It's been awesome to have you on today.

00:51:30:07 - 00:51:31:21
Erin Kenny
Thank you all so much.

00:51:31:23 - 00:51:40:01
Dr. Jaclyn Smeaton
If people want to learn more about you, about your practice, follow you online. What are the best ways for them to connect with you?

00:51:40:03 - 00:51:49:13
Erin Kenny
Yeah, you can always find us on all platforms at the celiac space. And so you can connect through us through DMs or through our website as well.

00:51:49:15 - 00:52:10:20
Dr. Jaclyn Smeaton
Awesome. Well, thank you so much. And thank you to all of you who are listening today. I hope you found this conversation as fantastic as I did. I want to remind you, if you like content like this, you want to learn more about health. You want to learn more about hormones. We release a new podcast every Tuesday, so you can follow us at digital on all the socials, and be sure to click subscribe wherever you're listening today so you can catch us every time.

00:52:10:20 - 00:52:12:21
Dr. Jaclyn Smeaton
We'll see you next week.

00:52:12:23 - 00:52:25:17
DUTCH Podcast
Thanks for joining us on the DUTCH Podcast. Join us every Tuesday for new conversations with leading functional health experts. If you like what you've heard, be sure to like, follow, and subscribe wherever you get your podcasts.