Wednesday, May 4, 2011

Retorts for unhelpful suggestions

I am lucky. Many people still remember just how sick I was before I went gluten free (it’s been more than 5 years, and they still remember). It’s not often that friends or coworkers or family question my need to stick, very strictly, to my diet. They’ve seen the consequences.

But many people who are gluten intolerant are not so lucky. Their friends, family, and/or coworkers challenge their diet at every turn. 

I can sympathize. Every now and then, there’s someone who doesn’t know me very well, who doesn’t understand celiac disease or gluten intolerance, and who just doesn’t get it. Someone who thinks I’m just being high maintenance for the fun of it. Recent news has seen people who provide "gluten-free" food that they know is filled with gluten, because they don't "believe" in gluten intolerance. 

As a very low maintenance type of person who needs this diet to be happy and healthy, it’s hard not to take their attitude personally. Such uninformed challenges to my need to be very careful about what I eat can be infuriating, frustrating, and depressing. I didn’t choose this disease. I have it. I’ve accepted that, but other people who don’t accept it, can still make it difficult. (Those who intentionally would poison someone like me? Well that's a whole other rant.) 

But such attitudes are not uncommon in the life of anyone on any kind of special diet. There’s something about diets that just gets under some people’s skin. I don’t get it. Why do people care so much what someone else chooses to eat or not eat, regardless of whether it's the cure for a disease, an attempt to lose weight, for their value system, or just a trial to see if it makes them feel better? 

Whatever the reason, people often butt in with brilliantly unhelpful statements like: 

  • Don't worry about it,” 
  • “Just pull the bread off,” 
  • “Oh, just relax. It's not going to kill you,” 
  • “Stop being so picky,” 
  • Just taste it; it's really good,” 
  • “Why didn't you come to our pizza party?” 
  • “I'm sure that's safe; it doesn't mention wheat, or
  • “Just eat it and deal with it.”

I recently heard someone new to the gluten-free diet ask how to respond to these people, saying they try to explain their symptoms and how gluten affects their body. I will educate people who are interested, who want to know how it affects me. But for those people who respond like uncaring idiots, thinking only about how my diet makes them uncomfortable — I usually don't go into details and try to explain all my symptoms. The people who respond this way just aren't the concerned, listening type. 


My advice: when you come across these people, just keep it simple and take care of yourself. It's always easier to come up with something after the fact, but when it comes to maintaining your composure and your diet, sometimes it helps to come up with them ahead of time.

Some potentially helpful (and some probably just wishful thinking) retorts
  • (Laugh.) No.No.No.No.No.Nooo. You — absolutely — don't get it. (Raise eyebrows and just leave it at that.)
  • No.No.No.No.No.No.No.No — No.
  • Cancer patients have chemo. Celiacs have a strict diet. All in all, I'm pretty lucky. 
  • It's just SO not worth it.
  • What are you, a sadist? Do you hate me? This stuff is like poison and extreme torture all deliverable in one tiny invisible speck.
  • Trust me, this diet feels absurd and having to be so ridiculously careful sucks. But unfortunately for me, it isn't a fad and it isn't a choice and the tiniest most minuscule — invisible to the naked eye —speck of gluten can make me suffer in totally unacceptable, unbearable ways.
  • Unfortunately for me, this diet isn't a fad and it isn't a choice. It's a medical necessity, and strict — ridiculously, stupidly, absurdly, frustratingly, annoyingly strict — adherence is the only treatment for what is a very destructive and potentially deadly disease.
  • Would you eat arsenic just because it were served at the table? Well for me, gluten is very much like a very strong poison. The “short term” effects are simply impolite for conversation, but they are utterly miserable and last weeks, and in the long-term, if I don't follow the diet, the results can be deadly.
  • (For those who know someone with the disease that is less carful) Yeah, I drew the short stick. Some people with this disease are lucky and have nice, mildly uncomfortable symptoms. They can cheat and have only consequences they are willing to suffer through and they don’t worry about the potential long-term consequences. But trust me, no one here wants to see what happens to me if I get even the smallest most inconceivably tiny speck of gluten. It's just not pretty. Sooo not pretty.
  • Trust me, I would love to not have to worry about this stuff. I am not a high maintenance person and I love food — Unfortunately, gluten is pure evil, and it hates me, and being anything less than ridiculously vigilant is a recipe for pain and misery like you wouldn't believe. 
  • Trust me, I've learned the hard way that I will pay severely for any slacking on being uber-careful about this.
  • If people were passing around heaping platefuls of radioactive waste, would you want to join them for lunch?
  • Do you get migraines? Migraines that make you vomit, don't respond to medication, and last for 4 days? Then don't tell me not to worry about it. 
  • This diet is ridiculous, and high maintenance, and it can be such a PITA, but the way I feel by being absurdly strict in following it, the complete turn around in my health, energy, sense of well being, and ability to function like a normal human being again — it's a life change in the BEST kind of way.

Why you can't cheat

When it comes to celiac disease and gluten intolerance, there seems to be this notion that "you can cheat, just not too much." To me, this advice is kinda like telling an alcoholic: it's okay to drink sometimes; just don't do it all the time.

For those who give this advice, I want to ask: What is the limit? We know it does harm. We know it can lead to fatal secondary conditions. So where do you draw the line? A pizza a month? A bagel a week? A cookie every few days? What amount has been established as safe?

Living Gluten-Free For DummiesDespite the careless advice often doled out. There is actually an established answer (depending on your interpretation of the results). Internationally, the most common standard for labeling something "gluten free" is less than 20ppm (though some people have a clinical relapse at smaller amounts). Essentially, they did some short-term studies that tested celiacs' responses to certain levels of gluten, and then set a standard based on the levels that most people did not react to in that period of time. In Europe, they lowered the standard from 200ppm because of these studies. (Having been to Europe before the new standard was in place, I can say I reacted noticeably to their "gluten-free" products.) So, if we've established that to be safe a product must have less than 20ppm — which is “…a fraction of a crumb. A teensy weensy fraction of a teensy weensy crumb” (Living Gluten-Free for Dummies) — how much more unsafe is it if you intentionally eat an entire piece of pizza?

There are not many studies that measure the long-term affects of various levels of cheating, because in the research world, it's accepted that the only cure for celiac disease is a "strict gluten free diet" ... not a "mostly gluten free diet".  Studies that examine the benefits of the diet long term exclude cheaters — and there's a reason for that.


Considering cheating? 

Here are some statements and studies to consider:

"Children and adolescents on not strict GFD [gluten-free diet] are at increased risk for low BMD [bone mineral densite]" (http://www.gfdoctor.com/bone-mineral-density-and-importance-of-strict).

"SMR [standardised mortality ratio] increased with increasing delay in diagnosis and for patients with poor compliance with gluten-free diet" (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2801%2905554-4/fulltext).


"The results are suggestive of a protective role for a GFD against malignancy in coeliac disease and give further support for advising all patients to adhere to a strict GFD for life" (http://gut.bmj.com/content/30/3/333.abstract).


"Long-term treatment with gluten-free diet produces a significant improvement in bone density in coeliac patients. Remineralization was more pronounced in patients who better comply with gluten-free diet" (http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2036.1997.112283000.x/abstract).


"Persistent villous atrophy in adult coeliac disease, even in the absence of symptoms, carries a risk of subsequent severe complications. The follow-up biopsy is important in detecting these individuals." (http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2007.03311.x/full).


"Excess morbidity was also calculated and was clearly related to the amount of gluten ingested (Table 3). The decreasing trend in higher morbidity rates with increasing adherence to a gluten-free diet was significant (p < 0.01)" (http://journals.lww.com/jpgn/Fulltext/1997/00001/Celiac_Disease_and_Malignancy.7.aspx).

"These results show that a strict gluten-free diet is protective towards the development of enteropathy-associated T-cell lymphoma" (http://www.springerlink.com/content/7745k17330431155/).