Met a Celiac on a 21 miler today

What are the odds of that?

That's the longest run before the Houston Marathon. Kinda glad its over.

Top Five Impacts on Celiac Awareness

This blog is about increasing awareness for Celiac, so I thought I would name my top five in what I consider to be most important for raising Celiac diagnosis rates and Celiac awareness generally in the last 10 years.

#1. The phenomenal growth of diagnosed celiacs - a self-feeding loop
#2. Celiac Consensus Meeting @ NIH - moved many doubters away from complacency
#3. Elisabeth Hasselback story and book - mass appeal
#4. Establishment of National Foundation for Celiac Awareness - first organization specifically focused on awareness to the exclusion of other activities
#5. Heidi Collins named NFCA spokesperson, cuts Public Service Announcement - brought star power and attention to the cause.

Blog post inspired by the survey at Savvy Celiac.

Gluten-Free lawsuit was just a matter of time...

Over the long term, there was a very good development for the Celiac community. A maker of gluten free mixes sued their supplier when they tested the supposedly gluten-free flour and found 60+ ppm gluten in it, prompting a recall.

The good news is that the gluten-free business is big enough now that real money and reputations are at stake. With this lawsuit, manufacturers also have real choices to make.

• Do I process gluten-free goods in their own dedicated facilities?
• Do I exit the gluten-free market?
• Can I effectively mitigate risks if I choose the middle path?

Just so you know, manufacturers -- Celiacs, given the choice between two products, are going to choose the ones made in facilities that do not process gluten as well.

Annual Goal Setting today

Usually toward the end of the year, I tend to get a bit contemplative and evaluate my life. The idea is that I just want to make sure my Christian values are lined up with what I am doing on a day to day basis, and that I am doing the things I love.

This year has been quite odd in that the mood struck me much earlier than the usual Christmastime/New Years. I'm not sure why. Maybe it's the new job(s). Or it might be that we just came off our family vacations (Disneyworld!). Or that my training is ahead of schedule and I am doing the mileage now that I would normally be doing in December. Or perhaps it is because we successfully completed another Celiac Awareness Run/Walk a few weeks ago.

Whatever the reasons, it is a very good exercise to be clear about what one wants to do and what one does not want to do. I have found it especially useful to have priorities about those "to-do's." The biggest differences between this year and those prior are the sharpness of focus and priorities. I also have fewer specific goals and more goals focused around process. This year, I hope to think (and analyze) less and do more.

Cedric Benson, QB move up depth chart after diagnosis

These kinds of stories never get old to me. Athletes suffer from Celiac disease, find out, and then improve once they start the gluten-free diet.

Here's a story that features Cedric Benson and his Celiac challenges prior to his current Pro Bowl caliber season with the Cincinnati Bengals.

Here's another great story about a celiac quarterback who moved up the depth chart and started against Alabama.

Revisited Soccer Last weekend

When I was in high school and college, I really loved the sport of soccer. I haven't played hard for a long time, until last week. Our church put together a festival for the Hispanic festival and I signed up. Fun.

Of course, the next day, I found muscles that I hadn't used in a long time. Still fun.

Yesterday, I made sure I took my first opportunity to get a flu shot -- not the swine flu one, just the seasonal one. It always knocks me back a step, but I figure it is good insurance against something worse, especially around race time. I was feeling a little bummed lately that I've been pretty distracted and my training has suffered, but my wife pointed out that I am well ahead of schedules from previous years, when I haven't been nearly as serious. That made me feel better.

Celiacs - check your freezer

I just saw this voluntary recall of Van's Pancakes. I keep telling my wife that just because it says wheat free on the box doesn't mean it is really gluten free. Now I can say that just because it says gluten-free on the box, it doesn't mean that it actually gluten-free, either.

Bruise count

Training is going really well for me right now, but I've had some of those "out of training" accidents. I was moving the woodpile (for the third time!) to get it away from the house. The exterminator recommended it because a woodpile basically invites termites. So I trenched around the house and moved the woodpile. One of the pieces hit my foot and caused a big ole bruise on my foot/ankle. It doesn't hurt (much) and I can run on it, but it could have been worse.

That makes about three bruises (new and/or healing), plus the ones I haven't found yet.

Why bring this up? Well, training for big long distance events is different than shorter ones. With shorter ones, you get injured and say, "Oh well," you rehab, and you do an event a few weeks later after you heal. Big long distance events are riskier. They usually involve a lot of training time and some travel expense. If you miss one of these events due to a freak injury, you may have to wait a month or even a year to try again. "Moving the woodpile" should be added to the list of "don't do this right before a marathon/big tri."

Reading around the web, now this Celiac has a reason to avoid remodeling projects, too - possible gluten in the drywall! Thanks for sharing that one.

Adjusted to the heat

My body has finally adjusted to the heat. It's still blasted hot to go running here in Houston, but at least the sun plays less of a role. This morning I did four miles with some hill work in the middle. Although my shirt and shorts were soaked through by the time I got home, at least it was a reasonable round trip.

I have a small swimming success to note. Yesterday at the pool, I did a push off and went nearly the length of the (25M) pool, underwater using a dolphin kick. I was on my side and noted that I was passing people. It's definitely faster than swimming on the surface. There is so much about swimming that is completely counterintuitive. I don't do every push off that well, but I figure if it happened once, it could happen again.

Feeling better in 2 weeks

Here's a heartwarming story for the karate enthusiasts in your life. It's about a celiac athlete who has a black belt. She went on the gluten free diet and felt better in 2 weeks. It's typical of athletes who have been diagnosed properly.

Humana won't take Celiacs in Texas

My wife was trying to price health care packages for our family. Humana had a big ad on the television, so she called and told them as part of the quote process that they would not cover Celiacs. The Humana representative admitted that "Celiac can be controlled through diet." but went on further to say that Humana did not cover Celiacs because "Humana can't monitor compliance with the diet."

This argument uses flawed logic. Using the same logic, they should not cover anyone who takes medication, either. Blood tests suffice. A little underwriting sanity appears to have gone missing at Humana.

Brilliant Celiac video from Mayo

Here's a great Celiac video from Mayo explaining the results of the Celiac study they published. He discusses the findings very clinically and very understandably.

At the end, he broaches the idea that one implication is that perhaps we should screen for Celiac in the general population, like we do for high blood pressure or cholesterol. I'm very much on board with that idea. It may happen on its own, anyway, because life insurers will start testing for the antibodies if they can.

Celiac 4x more prevalent in current Army recruits

I spotted this very interesting celiac article on Web MD. For some, currently unknown, reason, celiac disease antibodies were four times more present in current army recruits than those of the 1950s. This would imply that environmental triggers are to blame, which would imply we can figure out a way to decrease incidence of the disease, even in those cases where people were genetically predisposed.

It reminds me of the studies that showed the optimal time to introduce gluten to infant's diet. I wonder if the Mayo Clinic has checked for changes in that?

The other, more disturbing, finding, was that undiagnosed Celiacs of that era were four times more likely to die than the population at large. If that were to hold true to today's numbers... (Four million undiagnosed Celiacs four times more likely to die...). It is scary to think about and just confirms that it has never been more urgent to raise awareness.

California = Triathlon Mecca

I recently traveled to California. The first night that I was in Carlsbad, I realized why this area has so many triathletes. I took a run down to the beach. The weather was about 70 degrees with moderate humidity, and it stayed that way at night for the next two weeks. Unbelievable! I was about a half mile from the beach, and every day there were people enjoying the sun and surf. By the middle of the stay, I enjoyed trying to learn to surf. (I did more falling than surfing, but I think I have the basics down). And then I did an open water swim with the San Diego Tri Club -- fun fun.

About Tuesday of the second week, I realized I had been going hard every day for over a week, so I took two days off. It was so nice there. Then I came back to Houston, where it was over 100 degrees every day. Let's just say that over the last week or so my body has told me in no uncertain terms it would rather be where the temperature doesn't top 85. The schedule is out the window. I still need to adjust to the heat, but I'm doing longer and longer stints outdoors. Maybe I can try to get back on schedule this week.

Started Marathon Training today...

I recovered so well from the 5k on Saturday that I decided to start my marathon training early. I was going back over my training log and realized that I wanted to drop some serious time off of my marathon this year. If I use the pace calculator, my 5k times would translate to a very good improvement, so I've figured that the best way to go the distance would be to start the program and then take "backup" weeks if the training became to hard on me. It will leave me with about 4 or five times where I can take a break from the schedule if need be, but still be ready in January.

5k in 22:06 - Another post-diagnosis PR

This morning I ran in the local Heights 5k. It wasn't even in my calendar for a race, but I added it at the last minute because a friend invited me down there. I didn't do much in the way of a taper - I only swam yesterday (including a time trial 100 freestyle in 1:14) and did not run, and I altered the Thursday workout. I was especially pleased that I took 44 seconds off my best time in years. Houston is starting to get hot and humid.

Two months ago, I ran a 22:50, but this race was bigger with a competitive masters division, and I came in 40th or so in my age group today. So it just goes to show you. You can run much faster, and winning just depends on who shows up that day. I think its far better to have the attitude to improve against your own times than to tie success to place.

And a little fun, there was a camera crew doing "indie movie stuff" there, so maybe I'll be in a feature film someday.

Swam downhill on National Running Day

Yesterday was National running day, but it made more sense to focus most of my workout efforts on swimming. The workout was bike to the Y, short run on the treadmill (just to say I did), go to masters swimming, and then bike home.

We were working on breast stroke technique yesterday. I like to use breaststroke in triathlons sometimes, because you can get a really good view in an open water swim if conditions are rough or sighting is difficult. I thought I was pretty good at that stroke, but during the drills, the coach came up to me and said, "Michael, you are very flat in the water, which is good, but I want you to try something. On your entry, really push your shoulders into the water, like 8-12 inches under. It's not permanent, but I want you to try."

I'd been getting across in 7 strokes or so, and as soon as a tried it, I dropped to 5. Huge.

There are two ways to get faster in swimming - technique and yards. Technique is more fun.

Now if I could just get a tight flip turn...

Not every Starbucks...

I'm in the process of starting a business and had the opportunity to fly through DFW on a trip. I know the DFW airport pretty well, including knowing that there are three Starbucks in the main terminals. I thought-- Aha -- Lunch!

Alas, my hopes were dashed. It turns out that there are "degrees" of Starbuck-ness, and these outlets did not carry the new GF cake. Be warned and carry food appropriately.

Gluten Free Cake available at Starbucks

I had occasion to go into Starbucks today, so naturally I had to try the Gluten Free cake in the individual wrapper. It was good - 290 calories good. But it was small for the price, I thought. It's a great, widely available option for Celiacs.

My new running plan...

Ever since the last marathon, I've been in the pool more, but I've just been throwing together the runs here and there. I have been searching around for a new training plan and was thinking that I was going to do a "self coached" plan. But last week I stumbled across a really good book on running, called "Brain Training for Runners, by Matt Fitzgerald. ISBN 978-0-451-22232-9. And I've been doing some reading...

Despite the title, the core thesis of the book is not about "mental training," but how the brain interacts with the muscular, cardiovascular, nervous and other systems to determine racing, pacing and training effects.

The book is thick, but that's because it is half training plans -- from 5k's to the Marathon. I think that is just fine, because the front half is packed with running theory and studies. What I liked most was the studies he cited that effectively challenged some of my longer-held assumptions (example: lactic acid balance in muscles returns to normal in about an hour after a workout - who knew? Despite no change in my acid balance, I'm still going for a sports massage ). There were parts when I laughed because I knew from experience what he was saying was accurate. Interestingly, he ditches the heart rate monitor as a training tool in favor of pace-based approaches.

One weakness for Texas triathletes is that his section on heat and hydration was not terribly nuanced. As the book barely points out, heat is the one condition where mixed signals between the brain and body can have truly drastic consequences. Heat can kill. In my opinion, the section could have been stronger (and should have been) and included more variations in running speeds outside elite runners.

All that said, I learned a lot and I'm fired up. I started my 10K running program Sunday and will switch over to the marathon program in about 12 weeks.

Ironman Lottery results

April 15 is the day that the Ironman race in Kona releases the lottery results, which makes it a "fork in the road" day for my calendar. This year, they showed the results on the Florida 70.3 show, but I was driving back from visiting my sister in DC and wasn't watching. We did get to drive near a Saab with an IM sticker and a tri-bike on top for a while.

My wife was talking to her friend on the trip. Her friend's husband is a bit of a jokester (and a friend) and he told me to go "cry in my gluten-free beer" because I hadn't been selected for Kona. I was annoyed, because I knew that the results wouldn't be online for a couple of days, so how could he know? And he said that he was watching the Florida show. Knowing his viewing habits, there really must have been nothing else on or he was yanking my chain. I told him there was no way he watched it, and he told me I was in denial.

It turns out he did watch, and I was in denial. I've been doing the lottery for years and have not been selected. Bit of a bummer.

There are basically three ways to get into the Kona Ironman race:

1. Be fast
2. Be lucky << my default option
   
3. Be rich

One of the the things that surprised me this year was my level of annoyance. It went beyond the usual annoyance at being at the wrong end of a joke, and for the first time there was a bit of disappointment. Upon reflection, it had nothing to do with my friend (who simply spoke truth, right?), but was about a change in my attitude. I'm not sure when it happened, but I'm pretty sure I "wanted it more" this year. I think it indicates to me that maybe I need to really sharpen the focus of my strategy on the other two options as well.

Managed care insurers now have an economic reason to diagnose Celiac Disease

One of the barriers to awareness and diagnosis of Celiac disease has been the lack of enthusiasm on the part of health insurers. Now things have changed, and it is about time.

The Journal of Insurance Medicine has published a Celiac economic study by the Celiac Disease Center in Columbia that shows a decreasing cost after diagnosis.

"Researchers led by Dr. Peter Green, a professor of clinical medicine, said their study of a large managed-care database revealed cost reductions after diagnosis of celiac disease were attributable to decreasing trends in utilization of office visits, laboratory tests, diagnostic imaging and endoscopy procedures. "

This study is years overdue (see this two year old post including insurers), and it finally gives managed care insurers an economic reason to make sure all Celiac disease sufferers in their populations are diagnosed.

As a next step, I hope to see data-driven suggestions from these insurers soon. For example, it would be cheap and effective for them to send an email to segments of their population saying something like, "You have chronic iron-deficiency anemia. The differential diagnosis for that condition includes Celiac disease. Have you discussed it with your doctor?"

Our family in a field of Bluebonnets

Springtime is already here in Texas and the wildflowers are beautiful this year.

Many of the country roads have some outstanding blues and oranges courtesy of the wildflowers. The fields make for great viewing from a bicycle seat, and they last a few weeks.

Here's what we did Saturday after the race. Great post-race recovery, don't you think?

5k in 22:50 - Post Celiac diagnosis PR!

When I divide up my running times, I have two buckets divided by Celiac. There are my pre-diagnosis times and then my post-diagnosis times. Today I ran in a 5k, set a post-diagnosis PR of 22:50 (7:22 pace), and won my age group!

And I didn't taper all that much, either. The only change I did was an easy 30 minutes on the Nordic Trak on Thursday (It was raining, and I still did a hard swim on Friday.) We hadn't decided if we were doing the race as a family until last night.

Houston is in the middle of a cold snap, and it was 45 degrees this morning when we pulled out at 7am. That's very early for us. One of the challenges for this race was that they kept moving the start times around to accommodate the family walk and logistics, so staying warm while minimally dressed presented a challenge. What worked was taking my wind stopper mitts and hat to the start line and tucking them in to my waistband right before the start.

I ran hard, but I tried to focus on keeping my own pace, and I did. I went through the first mile in 7:20, and then eased of a hair for the second mile. A group of three passed me, but one of them came back to me at 2 1/2. Running down the last quarter was tough, but someone shouted out my name for encouragement and that helped. It was nice to run a small enough race to where I could count the people in front of me.

Now this afternoon, it's my wife's pick. We're off to the Texas Hill Country in search of the blue bonnets. If you're from up north, it's like going to the country to see the fall colors, except it's flowers in the spring.

IBS sufferers should be tested for Celiac disease

More news outlets are starting to pick up the concept that Celiac might be the actual cause of many undiagnosed symptoms. I saw this article on Google alerts the other day, repeating the story that IBS sufferers should be tested for Celiac disease.

Here's the guidelines if you don't want to go hunting for them.

IBS patients with diarrhea or a mixture of diarrhea and constipation should be screened with blood tests for celiac disease, a condition in which one cannot tolerate the gluten protein found in wheat and other grains.

Of course, this blog brought this health tip out nearly two years ago. While the GI docs seem to be getting the message out, it would be great if some of the others, like Dermatology and those involved with neurological disorders, could get on board.

A little insurance for Celiacs on the road?

I saw a recent posting on a Celiac site about a study from Finland. It said that:

"Bifidobacterium lactis inhibited the gliadin-induced increase dose-dependently in epithelial permeability, and, at higher concentrations totally eliminated the gliadin-induced reduction in transepithelial resistance."

OK - all fancy words that basically say that a probiotic kept gluten from getting through gut cells (in a petri dish).

Now, I think that's really hopeful news and here's how I'm going to use it. First, a petri dish is not a controlled human study. I am not going off the gluten-free diet to give it a try, and I think anybody would be nuts to do so. But from time to time, a restaurant will do that for me without my knowledge. We've all been there and done that, right? So I think that I'll just start taking a probiotic with B. lactis in it during times when I'm at higher risk (like on the road for a race or eating out a lot, for example).

I've had some pretty good luck using probiotics after a course of antibiotics and never had a bad reaction, so this seems to me to be a pretty good and relatively inexpensive way to keep ahead of the cross-contamination issue. Peaking correctly for a race or event is hard enough as it is, and this approach might just be some reasonable insurance on the diet side.

Should ear drops for swimmer's ear be gluten-free?

I haven't been posting for awhile, because after I started swimming again, my increased efforts resulted in a truly nasty bout of swimmer's ear. Very painful - very annoying - very tiring. So I was back out of the pool for a couple of weeks. Here's what I learned:

• I should have been using earplugs to keep out the water
• I should have used a half vinegar/half rubbing alcohol solution and dropped that in my ears before and after the workout. Evidently, the vinegar is the correct PH while the alcohol kills the infections before they get started.
  
• q-tips can irritate your ear canal, so don't go there
  
• Antibiotic ear drops were, bizarrely, very hard to acquire, resulting in an extra day of totally unnecessary pain
• I really didn't care if my ear drops were gluten free or not (but should I?)

That extra day of pain reminds me of the (thankfully infrequent) times when I am absolutely miserable and am asking a pharmacist if the medication is gluten-free or not. You'd think that this information would be readily available, but it isn't, and it's especially aggravating on the weekends when the manufacturer is closed.

It makes me wonder when the pharmaceutical industry is going to wake up on this topic -- probably not until people start reporting adverse reactions...

Anyway, I'm thrilled to be back in the water today.

Swimming more lately

I've started hitting the pool a lot more lately. I've joined up with a masters swim program and am trying to make it to the workouts more frequently than I did in the past. The noon workouts used to be pretty inconvenient for my schedule, but are less so now. I've already learned a few tricks to lower my stroke count, and I'm building water endurance. Win win.

20th Houston Marathon - 5:15

Well - let me start by saying that this year's highlight was that a local radio station called and interviewed me about running and celiac. I managed the 20 second plug about celiac being an underdiagnosed condition that people should look into. They also asked me about my 20 year streak and the problems I've run into - training in a cast, breaking a rib one year and so on... Hopefully, they'll send the tape, but it's been a week since the marathon and I'm starting to have doubts.

I was fit and ready, but I think I psyched myself out on this one and went out too fast. I just could not slow down for the first 14 miles, and then I cratered and the next four miles were a misery of walking. Then the nausea lifted and I held pace into the convention center. People tell me that it is unusual to "come back" after a bad spell, and I have to say I'd agree.

I think I've "noted" a few things:

• Must - Lose - Weight -- My Wii Fit even mocked me this morning by telling me my ideal weight for my height was less than my college weight when I was not absorbing food.
• Must - Follow - Pace - Band -- I was wearing it - just didn't follow it.
• Must - Not - Drink - Endurance - Didn't train with it, so why did I go stupid on race day?
• Must - Do - More - Base - Miles - I've become a master of the "just finish" and this year it really irritated me

The best part is that I finished my 20th consecutive Houston marathon, making me the youngest (I think) double-veteran. I can't wait to order the shirt!

20th Houston Marathon - 5:15

I think I psyched myself out on this one

Does Steve Jobs, Apple's CEO have Celiac?

I saw a post on the Motley Fool site about Steve Jobs. Mr. Jobs has lost a lot of weight recently. He is CEO of a major company, and Apple doesn't have much in the way of a succession plan, so even the Wall Street Journal is interested in his health.

It is not a stretch from a numbers perspective. One has to figure that there are probably four to seven CEOs of Fortune 500 companies having to work with the issue, whether it is known by them or not. (It may be that the effects of being an undiagnosed Celiac keeps people from the top job).

There were two things that I thought were interesting about the article. One was the "oblique" reference to Celiac. By "oblique" I mean that Celiac was mentioned, but it wasn't the focus of the article. It was mentioned as an aside, and I think that is a great development for Celiac awareness. The second item of was and continues to be Steve's struggle to maintain his medical privacy in the face of legitimate investor concerns. Can anyone imagine how difficult a situation it would be where you didn't feel comfortable telling your co-workers you have Celiac? Personally, I made the decision a long time ago to tell everybody. But what is good for me and what is good for Steve Jobs are two different things. Sometimes it is hard to be a celebrity.

Wednesday Update. A Time magazine posting mentioned Celiac as a possible cause.