Alyssa Chavez [00:00:01]:
Hello, and welcome back to the Endobelly Girl podcast. I have a special guest for you all today, Alexa Prass, who is a registered dietitian who specializes in celiac disease and other medically necessary gluten free diets. Now, you may wonder, okay, what does that have to do with endometriosis? But the truth is that there is actually a lot of crossover. There are certainly a lot of people who have both endometriosis and celiac disease, and there are also a lot of people who have endometriosis and have a gluten intolerance. So what we're really going to be talking about today is what gluten really is, how it can impact your body, what kind of things to look for if you're working to avoid gluten, how to know if you should even need to be avoiding gluten. And she has so much information to share with you all today. She has over ten years of personal life experience with celiac disease, so she has so much knowledge in this area. So if being gluten free is something that you know you need to do, but it's been a struggle for you, this is the episode for you.
Alyssa Chavez [00:01:09]:
If you are wondering why you should even consider being gluten free, if that's even something that's necessary for you, this episode is for you as well. So I will let Alexa share all of the information with you, and I hope you all enjoy. All right. Hello, and welcome back to the Endobelly Girl podcast. I have a guest for you all today, Alexa Pras, who is a dietitian specializing in celiac disease and other gluten intolerance type issues, which is very common with endometriosis. And she has so much wonderful information to share with you all today. So I'm excited to have her welcome, Alexa.
Alexa Prass [00:01:56]:
Thank you for having me, Alexa. I'm so excited to be.
Alyssa Chavez [00:01:59]:
Good, good. I'm excited for this conversation today. Yeah. Gluten intolerance is definitely something that's very common with endometriosis, but there's actually a lot of crossover, even between celiac disease and endometriosis. It's one of those things, like, all these health things just intersect, and it's so common for people to have multiple conditions going on at the same time. So I'd love to start out, Alexa, if you can just share a little bit about your personal story and journey and how you came to be where you are now and doing what you're doing.
Alexa Prass [00:02:33]:
Yeah. So my dad was actually first to be diagnosed in our family. So he was diagnosed with celiac disease, and celiac disease is genetic, so when he got his diagnosis, he kind of had a little trouble getting his diagnosis. It was kind of hard for him to advocate for himself to get the doctors to do the testing. So he had already had some knowledge about the disease itself and that it was genetic. So at the time, myself and my siblings all got tested. And so there's two kind of tests that they normally do for celiac disease. That's the blood test and then the endoscopy, which is kind of the gold standard.
Alexa Prass [00:03:11]:
So at that time, I was probably in elementary school. I was pretty young. I had the screening for the blood test. They were like, you likely could develop celiac. But then when they went and did my endoscopy, I had no intestinal damage at the time. So they were like, their recommendation was that I could continue eating gluten until I had symptoms. Because one thing with celiac disease is you can carry the gene and it never get turned on. So you could have the gene and never have intestinal damage.
Alexa Prass [00:03:44]:
And that's one of the things they're still kind of trying to study and really understand why some people, it turns on and does not. So I went for a long time with eating gluten and continuing to eat gluten while my dad and sister went gluten free. And we kind of had a shared household. Some of us ate gluten, some of us didn't. Certain meals, all of us ate gluten free. So it was kind of just how we worked. And then in high school, about my junior year, I started getting sick and feeling unwell, and I knew why that was. At least I knew.
Alexa Prass [00:04:17]:
There's a lot of people that go through, and it takes them years to get a diagnosis or understand why they're having these problems. So I kind of knew already this could happen. And then it was. So I was starting to have symptoms, and I was pretty resistant at first to go gluten free, because I had had some of the gluten free stuff we had in the house, and it wasn't always my favorite. So, yeah, I was pretty resistant at first, but I was like, I can't feel like this all the time. I couldn't keep doing that. And so I decided, finally, to go gluten free. And since then, so that was probably, like, 2012 ish when I was in high school.
Alexa Prass [00:04:54]:
And since then, I've learned a lot more about being gluten free. I've learned how to advocate for myself I've developed relationships and friendships where people support me, and we have putlux, and they bring me gluten free food and all these things. And so now having this diagnosis helped me actually lead me to diet headaches. I wanted to be a veterinarian my whole life, and then I had this diagnosis, and I started talking about it more with people and talking about nutrition, and I didn't even really know nutrition was something you could study or you could work in. And then I was like, oh, my gosh, I want to help people with these diagnoses because I see a lot on the Internet, a lot of fear mongering, or people giving misinformation or being super strict to the point that they have a whole bunch of anxiety around food and all these other problems. And so I just have started working towards telling my story, working with people so they can live their best life, even with their diagnosis, that they can still travel or have families or do whatever it is that they want and still do well and feel well with their diagnosis. So that's kind of where we are at now.
Alyssa Chavez [00:06:09]:
Nice. I love that. And it's so interesting. I think I would say pretty much everybody I've met who's anywhere in the nutrition world or health space, I feel like so many of us have gotten into it because of our own personal health journeys, but it lends something very beautiful because you have personal life experience with having celiac disease and knowing what that's all about and knowing what to look for and the symptoms and what to look out for when you're eating and going out and all of that stuff, which we're definitely going to dive into today. But I think it's so powerful that people who are struggling with that have somebody they can go to who actually gets it.
Alexa Prass [00:06:50]:
Exactly. Yeah. Because a lot of people, when they get a diagnosis, even if they are sent to a dietitian, having that lived experience and those nuanced things that you might not think about having, like a specialized dietitian or professional in this diagnosis when the only treatment is a diet, is really helpful.
Alyssa Chavez [00:07:12]:
Yeah, absolutely. Now, I would love to hear for anybody who might not even be familiar, can you share a little bit more about just what celiac disease is, what those symptoms might be to look for, like what you were experiencing when you were in high school, and then also, if you can start to touch base a little bit on what is the difference between celiac disease and having a non celiac gluten intolerance, because they're both becoming, I feel like more and more common, but there is definitely a difference between the two.
Alexa Prass [00:07:44]:
Yeah. So celiac disease is an autoimmune disease, and like I said earlier, it is genetic. So one of your parents has the gene, they pass it on to you. An autoimmune disease is essentially your body is reacting to something, and it's then attacking your own body. So in this case, it's gluten. When people with celex disease eat gluten, their body produces antibodies and then attacks, specifically your small intestine. And your small intestine is where you absorb all your nutrients from your food and so damaging. This is really terrible because you can have a lot of nutrient deficiencies, malnutrition, and that's kind of where all of your symptoms start.
Alexa Prass [00:08:28]:
So a lot of people will have GI symptoms, and those are kind of the most commonly understood and known, but there's actually over 300 documented symptoms related to celiac disease from anything from, like, brain fog and some neurological, as well as those more commonly known ones with the GI system. Bloating, diarrhea, constipation, just abdominal pain. And then a lot of people, we're on the Endobelly podcast, a lot of people have fertility issues because they aren't nourished well when they are having symptoms or actively still eating gluten. So, yeah, those are kind of the big ones, but like I said, over 300. And so that can really make it hard to get a diagnosis. If you have some of those less typical, quote unquote symptoms, like you might be like, oh, well, I have headaches or all these neurological things and not even associate it with, oh, I have celiac disease because it's not, oh, I'm having cramps and diarrhea. So it can be hard in that way. But then with the non celiac gluten sensitivity, it's kind of this broad term for people that might have reaction to gluten but don't have celiac disease.
Alexa Prass [00:09:49]:
So there's really not a good test for this at this point. It's really more of like, you've done the testing for celiac disease or a wheat allergy, and you know that gluten is something that you don't tolerate really well. Whether that be you have some of those GI symptoms, a lot of the symptoms do overlap, which also makes it hard. But if you've done the testing, you've done the blood test and the endoscopy, and they've come back negative for celiac disease. But, you know, you have problems with gluten then the doctor might give you this diagnosis of non celiac gluten sensitivity. But the one thing with testing for celiac disease specifically is that you still have to be eating gluten in your diet to get an accurate diagnosis. So what a lot of people will do, they realize they're intuitive, they know their body. They're like, oh, I feel really bad if I eat a lot of gluten products.
Alexa Prass [00:10:44]:
And so then they take it out and then want to go get a diagnosis. But they've been on a gluten free diet for a while, and then they get false results. They might get a false negative read, and they might have celiac, but they just did the test at the wrong time.
Alyssa Chavez [00:11:02]:
When I see a lot of too, and I'm sure you've seen people experience this as well. Once you've removed gluten for a period of time, whether it's a gluten intolerance or true celiac, I'm sure it would even be worse. And then you try to reintroduce it, say, oh, I really want to do that celiac test. Let me reintroduce gluten for a while so that I can get an accurate test result. You can end up having a much bigger reaction than you did before, because now your body has adjusted to not having gluten in your system and immune system has calmed down a little bit, and now you'reintroducing it and your body might freak out a little bit. So basically, if you want to get tested for celac, it's probably better to do that before you've removed gluten entirely from your diet, right? Exactly.
Alexa Prass [00:11:48]:
Yes.
Alyssa Chavez [00:11:49]:
I think that's probably a mistake that I made. My mom is also gluten intolerant. She's never been tested either, and neither have I for celiac. But we both did that where we removed gluten from our diet, and then I've been gluten free for years now, so I'm certainly not going to try to reintroduce it to get the test. But either way, I know that it doesn't do well for my body, so I'm just going to continue to not eat it and feel better doing that.
Alexa Prass [00:12:17]:
Exactly.
Alyssa Chavez [00:12:18]:
Yeah. Can you talk a little bit, too, about. We've talked about. Okay, celiac and gluten intolerance. Is your body basically reacting to gluten, not liking it? It is causing issues in your body. But one of the common questions that I hear from people who are brand new to this world and have never really heard about this stuff or talked about this before, is what actually is gluten, and why is it becoming, or why is it more of a problem for people these days?
Alexa Prass [00:12:52]:
Yeah. So gluten is a protein, and it's found in a couple of different grains. So it's found in wheat, barley, and rye. One note I like to always talk about is that there's a big conversation around oats. And oats are naturally gluten free, but because they're processed or grown, oftentimes really close to some of these gluten containing grains. For people that have reactions to have celiac disease or have this non celiac gluten sensitivity, it is recommended that you only eat gluten free oats, even though the oat itself is naturally gluten free. There's just a high risk of cross contact between those. But gluten is just a protein in these grains, and this protein helps with structure.
Alexa Prass [00:13:38]:
So if you eat something with gluten and then you eat the gluten free counterpart, you might be like, why is it so crumbly? It's because gluten helps with the structure in those grains. And so I don't know that it's necessarily that more people are having problems with gluten itself. I think people have more access to getting tested or understanding that this could be part of their problem, or reaching out to their doctors and getting tested and getting more information. And also, just like we're so connected with the Internet now that maybe it feels like more people have these problems that I think it's more about. Like, we just realize more people have these problems. Not necessarily that more people are getting a diagnosis these days, which I do think partially is true, just because it's more well known. But I don't necessarily know that there's more people that are having these problems today than they were before, just that we know more about it. Just more people actually have a diagnosis or whatever that might be.
Alyssa Chavez [00:14:46]:
Yeah, that's a great point, because I think there is so much more access to information now. People may have heard of celiac or just even the idea of gluten in general. I remember when I was a kid, nobody ever talked about gluten. I mean, I'm sure there was a community of people who had celiac and had to avoid that, but it was few and far between. But nowadays, there's so much information out there that I think more people are starting to realize that that could be a concern and are kind of looking into that and possibly receiving a diagnosis. If that's something that's going on. So, yeah, that's a great point. Now, when you're trying to avoid gluten, and you mentioned already the oats, which I think is a great point because there are certain foods like that that are naturally gluten free but can have that cross contamination or even cross reactivity and things like that can be a concern for people.
Alyssa Chavez [00:15:41]:
So for somebody who is maybe new to this and is having to just start to avoid gluten just in your day to day life, what are some of those common hidden sources of gluten that they might come across?
Alexa Prass [00:15:55]:
Yeah, so first I want to back up just a little bit. I like to talk about this, too, because I just think having access to the right language is really important. So cross contamination itself refers to microbes or anything that's going to bacterially make you sick. So salmonella on your chicken is cross contamination. Like, if you were to cut your raw chicken and then cut your veggies on that same cutting board, that would be cross contamination. But when we refer to a protein like gluten, it would be cross contact. It's a lot harder to use in a sentence. And there are a lot of times I still talk about it as cross contamination.
Alexa Prass [00:16:41]:
If I'm at a restaurant and I know people aren't going to know what I mean when I say cross contact, I will still say it, that's fine. But when I am talking with someone that might need to know, I want to give them the language and their correct language so that they can use it. Just wanted to win.
Alyssa Chavez [00:17:01]:
Thank you, because I actually didn't know that. I just learned something new today, so I will be adjusting my language as well. Yeah, thank you.
Alexa Prass [00:17:08]:
Yeah, of course. But like I said, I still use cross contamination all the time when people that are gluten free and don't need to know it. But, yeah, hidden sources of gluten, that can be really hard. I think one of the biggest ones is soy sauce or just sauces in general, especially ones that are thicker or even just like, seasoning packets and marinades are where a lot of things, or where gluten is a lot of times, especially if you're getting prepackaged meats and stuff or things that are just, like, preseasoned, that is probably where you're going to find a lot of gluten. So, yeah, it's hard because gluten itself isn't one of the big major allergens, and so reading food labels and is really important in this way or the ingredient label, I guess I should say, is a really important skill when you're eating gluten free.
Alyssa Chavez [00:18:06]:
Yeah, absolutely. Now, the beautiful thing I find really helpful these days is that a lot of labels will say at the bottom, like contains. It has that little section where it'll say contains wheat, milk, whatever of those more common issues for people are. So that is helpful. Is there anything in particular, though, on ingredients list that you should look for besides the obvious? Just it says wheat, that's a clear, or rye or barley, the things you mentioned before. But are there anything else on an ingredients list that people should be looking for?
Alexa Prass [00:18:41]:
So, yeah, those big ones, like you said, the contained statements are really helpful, but then there's all these laws by the FDA around what they have to put or what they don't have to put. So the contains label is definitely the first thing I look at. But those only have to do the big allergens. So you still need to look for the barley and the rye. Definitely looking for stuff like malt tritical, which is like another grain that has gluten. And it's like a weird mix between two of them. The soy sauce is a big one. Again, and I'm trying to think.
Alexa Prass [00:19:21]:
I read labels all the time and I'm like, what do I even look for sometimes? Natural flavorings or like the artificial flavors. In the US, they have all these proprietary blends or whatever for the companies, and that they're allowed to not tell you exactly what they put in it. So the natural flavors is something to look out for. Those are kind of the big ones.
Alyssa Chavez [00:19:46]:
Okay, great. Now, I find, and I'm sure many other people would agree with this, that eating gluten free at home is definitely a lot easier than eating gluten free when you're going out. Because eating at home, you can look at the ingredients list once you know what to look for when you're reading labels or just when you're buying food in general, I tend to stick with more of a whole food diet anyway. So I know that if I'm buying chicken by itself, it's not going to have gluten in it unless I add it in. So it seems to be much more manageable when you're at home and you're in that controlled environment once you know what you're doing. But what about when you are going out? Because, like you said, just because you've received some sort of diagnosis, you don't want to have to stop living your life and be a hermit and never go out. So what are some strategies that you would recommend for people who do want to still be able to go out and enjoy themselves, but want to also be smart about it and be looking out for their health and be able to avoid things that are going to irritate them when they're out and about at restaurants or at other people's homes and things like that.
Alexa Prass [00:20:54]:
Yeah. So that's definitely something that's going to take some practice and time. And it's also one of those times you really have to advocate for yourself. A lot of places do offer gluten free menus nowadays, and I would almost bet that every single one of them has a note that they can't be held liable if you get sick, if you have a celiac disease or a food intolerance. And that's just legal things they have to say. And there are some places that maybe even if they have a gluten free menu, it's maybe not safe. And so asking questions, either doing that beforehand, you can always look at their menu online. Most places put a menu online nowadays, or you can call them and talk to the manager and ask about their gluten free options.
Alexa Prass [00:21:44]:
Some of the big questions when you are there, depending on whether. So I like to go to places that already have labeled gluten free menus. It just makes it a lot easier. You kind of know what is available, what they know they're not having gluten free ingredients in, as opposed to looking at a menu and being like, this should be gluten free. If I do this or if I make this modification, it just can get really tricky at that point to just trying to use those gluten free menus, if they have them, and then just continuing to ask questions. Things like if they note that their fries are gluten free, asking if they're in the fryer with the chicken tenders or the fried shrimp or whatever other breaded things that they might have. And if they are, then it wouldn't be safe for someone with celiac or that has a severe reaction to gluten. Other things like what sauces are on the salad or whatever, or if the salad comes with croutons, if that's what you're wanting, and asking them to not put those on, and then just telling them that you have a severe reaction.
Alexa Prass [00:22:56]:
So I know that I feel like we were talking about how it seems like a lot more people know that they have reactions to gluten, or there's also been this fad diet thing with gluten and weight loss and so that some people just don't necessarily take you as seriously when you say you're gluten free or that you need a gluten free meal. So just being upfront and being like, I have a reaction to gluten sometimes. This is another place where it gets tricky, like celiac disease. What I have is not an allergy to gluten, but at times in these situations, it may be where I say, I have an allergy only because people in the food industry, they understand allergies. They deal with people with allergies all the time, and allergies are much more well known. And so it might be a time where maybe it's not the full truth. Like, it's not truthful that I have an allergy that's not right, but to help them understand that I have something so severe and that it will make me sick if I have gluten. And I make sure to tell them, even if the menu item is labeled gluten free, I still tell them I have a reaction.
Alexa Prass [00:24:13]:
And then also just asking kind of what their processes are when they're making the food. Can they change their gloves? Can they use a different cutting board and just kind of asking about their different precautions as well?
Alyssa Chavez [00:24:29]:
Yeah, I think that's really smart. And it's like you said, it's more probably about advocating for yourself than anything else.
Alexa Prass [00:24:36]:
Right.
Alyssa Chavez [00:24:36]:
Because.
Alexa Prass [00:24:37]:
Exactly.
Alyssa Chavez [00:24:38]:
A lot of places just don't even understand. I remember I was talking to a friend who is also gluten free, and she's not celiac, but does have a very strong reaction to gluten. And she was at a restaurant, and they had a gluten free menu and was told that, I forget what the item was. It was something that she was going to order, but she noticed it listed out. They give a little description, and it said something like, it has beer in the sauce. She was like, well, but beer has gluten in it, so doesn't that make it not gluten free? And the restaurant didn't even realize that beer had gluten in it, because it's just not something that is super commonly known if you're not aware of this stuff. So definitely knowing what you're looking for, asking questions and having clarity is super helpful. And there's certainly some truth to that.
Alyssa Chavez [00:25:39]:
Just some restaurants are going to be better than others when it comes to this stuff. For example, I know of a local restaurant where one of the owner is gluten free herself, and so has a very strong awareness of what this entails and they offer a lot of gluten free products. And I know that it's going to be safe there because the owner chef herself knows what it's all about. So you can always look for places like that. But the challenge, I think, comes in more often, maybe when you're going out with people and somebody else has picked the restaurant and you're having to kind of navigate as you go along. But planning ahead can be super helpful, calling ahead, knowing what you're getting yourself into, seeing if there's even something you can eat at all, or maybe make a different suggestion to the group you're going with or something if that restaurant is not going to work for you. But definitely the advocating for yourself piece of it is super important just in general for your health. Right.
Alexa Prass [00:26:39]:
And if you don't feel safe, you don't have to eat there. I have definitely gone, sat down, tried to order something, and I was like, I don't know. We're not doing this. It's not worth it to be sick. They didn't seem to understand what I was asking. They had no answers to my questions. We're going to find somewhere else, and like you said, that's really a lot harder if you're in a social situation or like someone else has picked the restaurant. But yeah, you don't have to eat somewhere.
Alexa Prass [00:27:10]:
If you don't feel safe or if something comes out wrong and you ask them to remake it, that's okay. And that's part of advocating for yourself.
Alyssa Chavez [00:27:21]:
So. Yeah, love that. Yeah, that's super helpful. That way you can have a game plan before you're going out to eat. I love that. Now, we've talked a lot about food and sauces and even beverages like beer, and there are some other alcoholic beverages that contain gluten. Is there anything beyond food that could also potentially be a source of gluten exposure?
Alexa Prass [00:27:48]:
So this is one of those places where it seems marketing and different gluten has almost become a buzword in a lot of ways. So you see marketed that this hand product or these body products are gluten free. But the thing with a lot of these gluten related disorders is that they have to get into your GI tract. You have to ingest them to have a reaction. And so the recommendation right now to the best of science we have is that unless it's like in or around your mouth, it's likely safe. Even if you do have celiac disease, even if you have a severe reaction, you can use these products. Even if they have gluten in them. It's not going to get through your skin and into your GI tract and cause you symptoms.
Alexa Prass [00:28:41]:
But obviously, it's up to you. If you choose to or want to buy these products, that's fine. But I was actually reading a study recently. There haven't, unfortunately, been a lot about the beauty products that are being marketed and stuff like that. But they had tested a whole bunch of lip products. So, like, lipsticks and chapsticks and stuff that had gluten containing ingredients. And even though they had these ingredients, they were still testing lower than the FDA level. That's considered safe for people with celiac disease.
Alexa Prass [00:29:13]:
So that's 20 parts per million, which is a very hard thing to understand. It's not a common measurement. No one really knows how to visualize that. But even crumbs are harmful to people with celiac disease. So you can think it's pretty small. But all the products that they had tested had gluten containing ingredients in them, but they were still testing lower than that limit that the FDA gives. That's backed by science. And so this could even be a kind of conservative recommendation to use lip, know, mouthwash, all those kinds of things.
Alexa Prass [00:29:51]:
That could still kind of be a conservative approach, but it's kind of the general consensus at this point that those are really the only kind of products that you might need to use that are gluten free.
Alyssa Chavez [00:30:05]:
Okay, that's good to know. Yeah. Because it has to actually get inside of your body that can give you a lot of peace of mind when it comes to just being around anything in general. So good.
Alexa Prass [00:30:17]:
But everyone's different. And if you are using products and you feel like you have a reaction of some sort, then obviously use what feels best for you.
Alyssa Chavez [00:30:27]:
Yeah, absolutely. Okay. Is there anything else related to celiac or gluten or any of the things that we've talked about today that you feel like we have missed, that you think is really important to share with people?
Alexa Prass [00:30:43]:
Oh, goodness. I feel like we've gotten to all the big points that I was thinking about talking about. Good.
Alyssa Chavez [00:30:50]:
Okay, well, that's a good thing. Covered all the important things. Love it. All right, well, then I would love if you can just tell us a little bit more about where people can find you, if they want to know more about you and what you do, how you work with people, what kind of resources that you have to offer. Where can people find out more about you?
Alexa Prass [00:31:12]:
Yeah, of course. So, currently, my day job is actually working as a hospital dietitian. This is my side gig at this point, but hopefully long term goal, full time gig. But right now I have an online course pre recorded called the basics of celiac disease. So it goes over kind of a little more in depth about all the things we went over, plus things like traveling and how to go into those situations and plan for that. Different events where food might be a big component, like a wedding or just different catered events like that. So all these different ways you might be exposed to gluten and how to kind of go into those situations prepared and still feel confident in those. And so that is my current offer right now, and I'm working on more.
Alexa Prass [00:32:06]:
The hope is that within the new year, I can start opening up some time to talk with people more one on one. For people that have already maybe started the gluten free diet, they have a diagnosis but are still struggling and that maybe these Internet searches they're doing aren't really helpful and they need more guidance and support one on one. But as far as where to find me, I'm on Instagram, so I have two. One, because celiac disease is a big part of my life, but it's also not my whole life. And I have other interests and things, so I like to share those as well. And so that's Alexa Prassardian. And then my business one is gluten freedom nutrition, both on Instagram. And then I have my website, glutenfreedomnutrition.com.
Alyssa Chavez [00:32:55]:
Perfect. And we will share all of those links in the show notes as well. So if you're looking to get in touch with Alexa, you can find all of that there. If you are driving and don't have a pen to write this down, you can find all that in the show notes. All right, Alexa, well, it was so great having you on here today. I think that is great information for people to hear. Hopefully, that brings more light onto celiac and gluten and all the things that people might need to be aware of. So thank you so much.
Alexa Prass [00:33:23]:
Thank you. Bye.