Episode #15: What is Celiac Disease? with Dr. Tyrrell Jenkins
INTRO: Welcome to Healthy Sexy Nutrition with me, Michelle Fox, culinary nutritionist, health coach, and your host for this podcast. I teach busy professionals how to get more nutrition in their bodies and how to have more fun in their home kitchens. If you struggle with consistency or sometimes forget to make your needs a priority or you avoid planning your meals, you, my friend, are in the right place.
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So let's dig in.
MICHELLE FOX: Today we are talking what is celiac disease and how can you heal with my friend Dr. Tyrrell Jenkins, which I will introduce you to very shortly. I am so excited to have him on the show, but let's see if I can get through his bio, you know, in all this excitement so that you know exactly who we're talking to and what we're talking about today.
So Dr. Tyrrell Jenkins, affectionately known as Dr. TJ, his medical journey started by attending Howard University College of Medicine, that's in Washington DC where he also completed his residency in internal medicine. He then became chief of hospital medicine at a regional hospital in Maryland. Then he moved to the New York City area.
Some of you know that's my stomping ground, so we'll, we'll probably talk a little bit about that. I dunno if he knew that in a minute. And that is where he currently practices primary care in private practice. So Dr. TJ's hope is that his business Crave Wellness, will help people gain medical knowledge and learn of amazing wellness destinations that will truly make a positive impact on the quality of their life and their community.
So Dr. Tj, Welcome.
DR. TYRRELL JENKINS: Hello, how are you, Michelle?
MICHELLE: I'm well. How are you?
DR. TJ: Pretty good. Pretty good. Thanks for having me on. I’m excited.
MICHELLE: My pleasure. My pleasure. And now, did you know that I went to NYU? Did we share this before?
DR. TJ: I did not. I, I read it once somewhere and I thought that was a little hidden gem you kept from me. So that's so exciting.
MICHELLE: Yes, for a lot of these interviews, I do my best not to give away too much in the beginning because I think it's nice and fresh when we can share the real deal with our community.
DR. TJ: Absolutely. I love New York City, obviously. And going there for college, I could imagine that was, you know, a pretty fun experience.
MICHELLE: Oh my goodness, yes. That's like a whole nother episode that we'll have to get into. But yes, definitely grateful for the opportunity to, to be in that city. It, there's like a whole world away, but yes, I love New York. And now I'm here in Denver and, and I love Denver.
DR. TJ: Excellent.
MICHELLE: Yeah. But speaking of sharing personal things, are you willing to play a warmup round of rapid fire questions with me?
DR. TJ: Whew. Sounds tough, right? I'm ready.
MICHELLE: I promise it won't be too tough. I'll go easy on you.
So first question, and this is a serious one.
DR. TJ: Oh, okay. I'm ready.
MICHELLE: Sweet, salty, or savory?
DR. TJ: Sweet.
MICHELLE: Oh, okay. Okay.
Cats dogs?
DR. TJ: Definitely dogs.
MICHELLE: Oh, good. I, I knew we could be friends. I'm the same.
DR. TJ: For sure.
MICHELLE: Favorite movie of all time.
DR. TJ: Oh, this is a really tough one. Okay. I'm not sure it's my absolute favorite movie of all time, but it just came to mind. Benjamin Button, What is it the one…
MICHELLE: Oh yes. Where he like ages backwards.
DR. TJ: Right, right. That was such a bizarre but creative movie. So I will go with that one.
MICHELLE: And this kinda ties in for the last question, Would you be willing to share one of your favorite childhood memories in the kitchen with us?
DR. TJ: Sure. So I'm originally from New Orleans, Louisiana, and my dad is a huge cook. You know, love and enjoy cooking meals, those things like that. So spending times with him, making red beans and rice ,ooh,
MICHELLE: Ooh. Oh, that's so good.
DR. TJ: Louisiana would add and Dewey sausage into the, the kind of dish and I would add a little seasoning, little spice to it. So definitely memories there.
MICHELLE: That sounds amazing. And we are around lunchtime here in Denver, so I'm like, that sounds delicious.
Well, let's jump into our topic of today, which is, what is celiac disease and how can you heal? And before I ask a direct question, I know some people in my community know that I was actually diagnosed with celiac disease about 20 years ago. I was trying to get pregnant with my daughter at that time, and we tried everything and nothing was working well. Everything short of IVF, we, we didn't go down that route. But my doctor, my OB at the time, she's like, “Well, let's just take this little test cause I have a hunch.” And I'm like, Okay. And it turns out not only am I gluten intolerant, but dairy intolerant as well.
And so we can, I know we're we'll talk a bit about that cause I have a few questions around that, but, one of the first questions I actually wanted to jump into and kind of talk around is the difference between celiac disease, gluten intolerance, and I promise there will be a question in there in a moment, but I also wanted to share that my doctor at the time, and I wonder your opinion about this. She said that whether I have celiac disease or I'm just simply gluten intolerant, that the solution is the same, which is don't eat the wheat. So she's like, “Why would we put your body through this invasive surgery just to prove, you know, quote unquote prove that you have celiac disease when the solution is the same.”
So let's take a few steps back and people that are looking at me like, “Okay, Michelle, what is celiac disease? I know you keep throwing gluten at us.” But just at the basic level, like what would you, or how would you define celiac disease?
DR. TJ: Yeah, exactly. So celiac disease is, it's basically a person who has an allergy to a dietary gluten. You would consume gluten, it is absorbed in your small bowel. At that point it starts to trigger an inflammatory response. To simplify it. We have like these finger like projections on the lining of our intestines, right? And they're called villi and they're responsible for absorbing nutrients, vitamins, minerals, things of that nature.
It's also responsible for maintaining a good barrier on our intestines, keeping things in check. So whenever you have celiac disease, you have this gluten intolerance, you have an allergy to gluten. So as it's trying to be absorbed, the villi ends up becoming inflamed. That inflammation leads to atrophy, which is the breakdown of those fiber finger-like projections, and that causes a cascade of problems and symptoms that oftentimes are the things that bring a person into an office like mine.
MICHELLE: Yes. And I imagine, and tell me if I'm wrong, but I imagine the people coming to you, are they most likely complaining about gut issues and stomach pain?
DR. TJ: Yeah, so there are a slew of signs of symptoms of celiac disease. Definitely the most common is going to be abdominal pain, bloating, irritable bowels, meaning sometimes constipation, sometimes very loose stools.
But you also have a few other interesting signs of symptoms of celiac disease besides just the gastrointestinal ones that I mentioned. So for instance, I had one patient came in with numbness and tingling of their fingers and toes. Brittle hair you mentioned earlier, right? So even fertility miscarriages are associated with celiac disease.
So there's a few things that we have to think about. The neurological part, so the brain fog you know, memory impairment, but then also the gut manifestations.
MICHELLE: Yes, And the reason why I ask it in that way is because in my research, and I would love again to know your opinion, but my research is that celiac disease truly is more of a brain disease, and even in the gut, like a lot of the symptoms manifest that way, but, I can share that like if I come into contact with gluten, I am moody. I am in a bad mood for like a solid four days where people are like, “Okay, what's wrong with her?” When I know that I'm acting like outta my mind, that I'm like, Yeah, okay. I think back to maybe in a restaurant, or maybe if I was at a friend's house and I'm like, “Oh, I bet I got in contact with gluten.”
Then I'm like, Okay. Like it really, Oh, and then depression. Like I can go into a quick depression and what you know of me, I'm sure you know, I am not a depressive person. So when I start feeling those feelings, I'm like, “Okay, what did I eat? And where did the gluten get in?” So do you see it as more of a brain disease as well?
DR. TJ: For sure. You know, our gut is one of the the biggest part of our immune system, so if you think of your immune system being impaired, everything's gonna become impaired. So your nervous system for sure. So it certainly can affect your, your mood, it can affect your energy level, how you process information.
So those signs of inflammation, we call 'em cytokines, can definitely cause neurological issues. So that definitely is something if a person is experiencing unexplained neurological issues and they also are perhaps having some gut issues as well to get screened for celiac disease.
MICHELLE: I love that. So now I would imagine I'm quite a few years older than you. And the only reason I bring that up is because 20 years ago when I was diagnosed with gluten intolerance, there was not a lot of research and if there were, people just weren't aware of it.
So in my experience it was, you know, going to restaurants and chefs being like gluten, what? All the way to going to doctors who were like, “That's in your head, that's not a real thing. It hasn't been proven.” To now you, like, it's just been so refreshing to hear that you're like, “Yes, this is a real thing and this is what causes it.”
So how did you even become aware? Like was it part of your curriculum, part of your background? Like tell me your adventure with celiac disease.
DR. TJ: Yeah, so it certainly came up in my first year of medical school.
MICHELLE: Okay.
DR. TJ: Medical school is like drinking from a fire hydrant, so, you know, it's a lot of information that comes at you. So knowing what the condition was, how to diagnose it, and then the next step was management. And then obviously it came up in my board exam. And oftentimes on board exams, they will test you for things that is an unknown or, or underdiagnosed, I would say. So you're seeing it in the population, but physicians aren't catching it. So a lot of board examiners will put questions on your board exam to kind of test your knowledge on those information. And so it came up on a board exam for, for instance. And then obviously in private practice I see patients as well, either with that diagnosis established or kind of forming a diagnosis due to clinical testing.
MICHELLE: You just don't even know how happy that makes my heart. So it's like in the mainstream now, like doctors are actually looking for celiac disease, it sounds like.
DR. TJ: Sure.
MICHELLE: Awesome. Oh, love that. And you just mentioned, you know, that maybe patients coming in. Have you had anybody recently come in that you were like, “Well, let's just check this out”, or maybe they were presenting in a certain way and it turns out that they did have celiac disease. Like have you seen that in the last year or two?
DR. TJ: For sure. So last year I remember I had a young male patient, probably in his thirties or so, you know, new family, a lot of stress going on and was attributing. The neurological part, but then also fluctuating bowel movements to new jobs, stress, you know, 2021, just coming out of, you know, lockdown, everything like that. He had been tested, interestingly for celiac disease previously, but not the best test. So went back to eating gluten and was noticing that his symptoms were kind of manifesting again. So, ended up establishing with me. We had some conversations, did a test, came back, positive antibodies for celiac.
I advised to do a, what we call a food and symptom journal. So what do you eat? Do you experience any symptoms? Or you can go the opposite way. Are you experiencing adverse symptoms? Then try to recall what foods you had recently. And that was a good way of identifying that. Yeah, it was likely gluten as a trigger and yes, blood work confirmed that.
So I actually had a follow up with him for his following year, annual physical. Night and day difference. He was experiencing weight loss as well, right? Yeah. Unintentional weight loss, you know, worried of course about malignancy or things like that. Stress was that an issue? And here it is. It was just, you know, celiac disease, gluten.
MICHELLE: I love that. And there's a, a few things I wanna highlight. One that you were aware enough to do the testing to catch it. Two, that the patient was willing to do the testing, but then three, even bigger sounds like he was willing to do the work to make the changes to feel better in his body.
DR. TJ: Absolutely. You know, who wants to live a miserable right. Existence. I think the biggest thing is getting to the root cause of the problem or the issue. And sometimes it's not just medications, just, you know, putting a bandaid on a, on an issue on a problem or chugging it to someone else. So he was open to it and it's a, it's a significant lifestyle change, obviously. So I'm very happy that we got some good result.
MICHELLE: I will share that in my journey, I. I did do that two year old temper tantrum. I would say the first six months after I got the diagnosis, because it was interesting when my doctor said, you know, no more gluten, I immediately went into, “Well, this isn't fair.” Like, “why do my siblings get to eat fried chicken?” You know, “why does my husband at the time get to eat pizza in my face?” Like I just, I was resentful and so I did kind of slide and like get, you know, put the gluten back in. That's being, I guess, very kind. I would just say I, I ate whatever I wanted to eat, and then of course, not surprisingly, got the bloatedness right away, got the mood, got the, you know, just the horrible feelings.
But I just wanna add that to share with people to have compassion with themselves. Cuz sometimes these types of diagnoses can be really scary. It's like, I've had this way of living all my life, you know, at that time I was 26, 27, and now you're asking me to completely change everything. I mean, that's what it felt like.
But now that I'm in culinary nutrition, I'm clear that there's so, so, so many ways to eat well, Eat Delicious that are perfectly gluten free, so it's been a journey for sure.
DR. TJ: Not easy, but you know, knowledge, right? So understanding the, the disease, the disorder, the condition, and then empowering yourself to be able to make those changes in a, in a very healthy manner. So, Oh, absolutely.
MICHELLE: And now I also love that you highlighted the food connection. When we talk about healing from celiac disease, besides eliminating the gluten, do you have any other suggestions for us to heal?
DR. TJ: Yeah, so I would establish a baseline because oftentimes with celiac disease it will cause mineral or vitamin deficiencies. So the biggest vitamin B12, folic acid those are gonna be your biggest ones. Iron. So if you're anemic, you wanna get those baselines because you want to know what do you really need to focus on and improving those deficiencies in your diet due to all the inflammation and the damage that celiac cause.
So getting a vitamin B12 level, getting a folic acid level, and seeing if you're anemic, and then seeing what food groups you know, have high sources for those deficiencies.
MICHELLE: I love that. And of course, with culinary nutrition, I can tell you I often recommend my clients do lean on some of those B12 heavy foods.
So that could be eggs. That's actually my favorite. I actually just boiled seven eggs. I like to boil like seven eggs at the beginning of the week so I can eat it throughout the week and have snacks. And so that's a great way to get it in.
Tuna is also a great way to get in that B12. Trout and salmon are for my, I don't say vegetarians, but what's that term for pescatarian or something? Thank you for my pescatarian friends. Yes. I just finished a 30 day group nutrition coaching program, and a handful of my participants were pescatarians.
And that was one of the things on the feedback form was we wish there were more. Recipes with fish. So I'm like, okay, duly noted. Moving forward. Fish more fish.
DR. TJ: Yeah, fish is a great source for B12. Plus we know it's very good for lowering your cholesterol as well. So also the source vitamin E I believe. So omega3 fatty acids, so definitely.
MICHELLE: Now, what about supplementation? What is your take on supplements?
DR. TJ: Yeah, no, good question. So it seems like the optimal level, if we're speaking about B12, off the top of my head, it's probably around 500. Okay. When you start getting to the 300 s, definitely no. You can definitely start having manifestations like neurological, numbness, tingling, fatigue, you know, you name it. So for me if I have a patient that is 100, 200 for their B12 level, usually I would do intramuscular shot for a B12.
MICHELLE: Oh wow.
DR. TJ: If you're into that. That's fine. You can do oral or sublingual vitamin B12. 1000 micrograms oral sublingual. There's some research out there that maybe sublingual is better than oral. Who knows, but long as you're getting it in. So I am a, an advocate of supplementing, especially if you have a male absorption condition.
MICHELLE: And how would somebody know, like what type of tests would somebody ask their doctor for?
DR. TJ: Yeah. So for B12 not only getting a vitamin B12 level, but something called methylmalonic acid, so your methylmalonic acid level will be high if you have a B12 deficiency. And the reason why I say add that on is because it may appear that your vitamin B12 level is normal, but you actually can be deficient. It will be like a false kind of reading in a sense, whereas methylmalonic acid level will truly tell you if that person has a vitamin B12 deficiency or not. So basically, long story short, don't be completely satisfied if it seems like your B12 level is normal, probably want that next step. Folic acid is important, especially for women who are in family planning stage because folic acid is important for the fetus, nervous system development. So checking a folic acid, oftentimes prenatal vitamins will have a higher amount of folic acid. Folic acid you can get from greens, vegetables, things like that. So supplementing either via diet or multivitamin, which always will have folic acid in it or a standalone folic acid. I think the dosage is maybe like one milligram, but you would have to check iron. So if a person is anemic, you're gonna see low hemoglobin levels. So the test for that is called a complete blood cell count. It's a routine test that you have done at your annual physical and you're looking at your hemoglobin hematocrit levels.
Obviously, male and females have different levels. Obviously with aging, we expect a person to slowly develop maybe a degree of mild anemia. We would call it clinically insignificant, but it, it gives you a sign of your, your bone marrow kind of function, how well it's incorporating iron, and then kind of utilizing that in the synthesis or the makeup of red blood cells. So getting your CBC checked.
MICHELLE: Oh, I love that. And is, I'm trying to be careful so I don't sound offensive. I will say you are amazing. Oh, appreciate it. And. Not all physicians are amazing at looking at the details and or a lot of us, I will say especially women over 40, when our hormones start to change dramatically, there's not a ton of research, at least not a ton of published research around menopause and menopausal symptoms. And so in a lot of my coaching, I'm coaching people to be advocates, self-advocates. And so I say all that to say, let's say somebody from my community goes to their primary care physician, ask for these tests that you're mentioning. And the doctor said it's fine, but the person like knows, kind of intuitively, you know, something's not fine, something is off. Like is there a place on the internet where they can compare numbers or like, how, how could we do some of maybe of our self-research just to double check to make sure we're getting the right answers.
DR. TJ: Got it. So that is definitely a question that put me in a bind, so…
MICHELLE: Okay. Sorry.
DR. TJ: No, no, no. I am a huge advocate of patient being informed, being involved in their healthcare. You absolutely should. Sometimes Google MD will cause a person spiral, so I. Every day. Where you know, it's a bump, a simple pimple. Google MD will say it's cancer or whatever, or mild anemia that isn't clinically significant. Google MD will say, Colon cancer. You know, obviously all of these things are possibilities, but I think having a physician that you truly have a trusting relationship where you have a rapport with. If you don't have that, then finding someone else.
So you have to be able to lean on their medical expertise, their guidance and if you find yourself with one that is very dismissive you know, in and out. Not able to answer your questions, and it sounds like that's not gonna be a good advocate for your health. I think, yeah, speaking to family members perhaps who are in the healthcare industry field, whether it's nurses, PAs, physicians, technicians, you know, because oftentimes your numbers on your blood work may be outside of a range, but it isn’t, as I used that word, it just previously clinically relevant. It's, it's nothing that's gonna change or anything. Nothing for us to chase behind things of that nature.
MICHELLE: No, I absolutely love what you said, which is keep asking.
DR. TJ: Yeah
MICHELLE: So if something in your intuition is saying, I don't know about this, like there's no harm in getting a second or a third opinion, right?
DR. TJ: Yep. Second, second opinion does help. Also, keeping a track of your blood works and the trends. Trending is very important, so you know which direction you're going in, if you're improving, not improving, having a list of questions before you go in to an office visit, because oftentimes patients will come in, they get, you know, nervous. Maybe there's a level of intimidation. So having that list of questions so that you're very clear.
MICHELLE: I absolutely love and adore that answer. Including, I will add, just as a an alert, let this be your sign to anybody in our community if you have not seen your primary care physician, please make that appointment before the end of this year.
I know a lot of us have gotten off schedule with the pandemic. People have been putting off certain appointments, but I am begging you, your health matters. Please make that appointment. So Dr. TJ, this has been wonderful chatting with you. 30 minutes goes by way too fast. I still have more questions. So with that, can, can I have you back one day?
DR. TJ: Definitely, definitely. I mean…
MICHELLE: I would love to dig more into supplementation and perhaps we could even focus in more on the self-advocacy for the woman over 40. I mean, there's, there's so many ways we can go.
DR. TJ: We can.
MICHELLE: So tell me, where can my community find you?
DR. TJ: Absolutely. So my company is called Krave Wellness, and we're on Instagram it's krave.wellness and that's krave with a K. And then we're also online www.kravewellness.com. Obviously you can follow us on Instagram or you can subscribe to our newsletter.
I have a freebie on the website of anti-inflammatory foods that you can bring to your grocery store to help you shop.
MICHELLE: Well, thank you so much for sharing your wisdom. Thank you for showing up for us. Thank you for showing up for the community cuz clearly it shows that, that you care and you do have a heart for wellness.
So thank you Dr. TJ.
DR. TJ: Any time Michelle. Great to see you again.
MICHELLE: All right, we'll talk soon.
DR. TJ: Have a great one. Bye. Bye.
MICHELLE: Thanks so much for listening to Healthy Sexy Nutrition. Have you been driving, doing laundry or walking around the neighborhood? Sweet. I've got show notes for you at michellefox.com/podcast. Click over there when you are ready. I will let you know that on the page you will find resources to support what you just learned on today's show.
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Big love from your favorite culinary nutritionist and health coach, and until next week, keep showing up for yourself and know that you and your health matter.
You deserve to live in a body and have a life that you love.
