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Celiac disease is a lifelong, chronic disease of the small intestine in which the adhesive protein gluten is absolutely not tolerated.
When gluten (also called gliadin) is eaten, the lining of the small intestine is damaged. There are complaints such as insufficient digestion of nutrients (this may result in unwanted weight loss due to the intestinal damage), abdominal pain (abdominal complaints), flatulence & or diarrhea.
Gluten is a grain protein and occurs naturally in wheat, spelled, green spelled, rye and barley.
By consistently avoiding gluten in relation to all foods that can contain gluten, including cosmetic products and medicines, the damage to the intestinal mucosa is reduced and regenerated, so that all nutrients can be reabsorbed (reabsorbed).
Why is nutritional therapy important?
Nutritional therapy helps you to integrate a gluten-free diet into your everyday life, to exclude sources of contamination and to be safe when traveling, visiting restaurants or hospital stays.
The aim is to supply all of the fatty acids, micronutrients (vitamins and minerals) that are important to you, energy and protein in the measure that your body is optimally supplied with. For this purpose, foods that promote inflammation are specifically avoided and plenty of anti-inflammatory foods are consumed. Weight reduction is recommended if you are overweight / obese. An anti-inflammatory diet can improve your health.
Differentiation of 3 diseases, which are similar in their symptoms (important for the daignosis position!)
Celiac disease, gluten / wheat sensitivity and wheat allergy
Autoantibodies: Positive (high sensitivity and specificity) celiac disease
Autoantibodies: Negative (except for anti-gliadin antibodies IgA and / or IgG) gluten / wheat sensitivity
Autoantibodies: positive - wheat allergy
Damage to the intestine as a sign of the disease:
Enteropathy: typical of celiac disease
Enteropathy: absent; occasionally IEL slightly increased, (Marsh 0-1) - gluten / wheat sensitivity
Enteropathy: wheat allergy is absent
The symptoms are the same for all clinical pictures: intestinal and extraintestinal
Celiac disease: Lifelong gluten waiver, a gluten-free diet must be strictly adhered to.
Gluten / wheat sensitivity: The gluten-free diet can be limited in time. The time frame should not be less than one to two years. The tolerance threshold is different for patients with NCGS, ie the gluten intake must be adjusted individually
Wheat allergy: Temporary avoidance of foods containing wheat may be rich. Administration of cortisone may be necessary.
Important - If you do not have a clear diagnosis and are already following a gluten-free diet ahead of time:
If you are already on a gluten-free diet and then have a gastroscopy performed to take a sample, there will be no intestinal damage! This means that you may have celiac disease, but this cannot be determined because your intestines may already have regenerated due to the gluten-free diet.
Please do not switch to a gluten-free diet until you have received confirmation from your doctor.
A blood count alone is not meaningful!
Please always have a gastroscopy with a small intestine biopsy performed.
If you think you have celiac disease, please make an appointment for a gastroscopy directly,
as there are sometimes very long waiting times.
Frequency: 1 in 100 people will develop celiac disease
There are 2 types of celiac disease:
Subclinical celiac disease: damaged intestinal mucosa, but those affected have no symptoms
Potential Celiac Disease: Individuals have high levels of antibodies but no changes in the intestinal lining
Attention with the following findings - please also have an examination for celiac disease:
unexplained iron deficiency anemia / unexplained chronic diarrhea / irritable bowel syndrome
Children with newly discovered diabetes mellitus
Diagnosis: Gold standard : gastroscopy with small intestine biopsy (duodenal biopsy) & blood test
The blood count is used to search for antibodies (anti-bodies) that are typical of celiac disease.
The diagnosis is confirmed by a biopsy of the small intestine. Tissue samples are taken from 4-6 sections of the small intestine and examined microscopically for villous atrophy (damage to the intestinal mucosa.
Determination of transglutamine IgA antibodies and total IgA alternatively endomysial IgA antibodies
If the total IgA is low: Determination of transglutaminase IgG antibodies or IgG antibodies against deamidated gliadin peptides
Since nutrient deficiencies are often observed, the following laboratory parameters should be determined in accordance with the guidelines: Differentiated blood count:
Albumin value (protein), ferritin, folic acid, Vit. B12 (methylmalonic acid), zinc, calcium, Vit. D, TSH, GOT / GPT.
For a diagnosis of celiac disease, at least a change in the mucous membrane according to type 2 is necessary and is an important criterion that is required for a reliable diagnosis of celiac disease.
Notes on taking samples (gastroscopy)
Samples are best taken at different locations and levels along the duodenum. If possible, samples should be taken from the first section of the duodenum, the so-called duodenal bulb , because the changes can sometimes only be found there.
But: biopsies from other sections of the intestine, especially at the end of the small intestine, would not be suitable for diagnosing celiac disease.
Even with colonoscopy , in which the anus or the end of the large intestine, the so-called terminal ileum , reaches the small intestine, the samples cannot be used diagnostically , even if changes can be detected there in some cases.
In order to reliably diagnose celiac disease, 5 - 6 samples must be taken because the changes in celiac disease do not always occur evenly (patchy lesions).
This increases the reliability of the diagnosis.
Classification according to Marsh:
Type 0, 1, 2 -> no celiac disease
Type 3 = destructive type = celiac disease is diagnosed with this type!
Type 4 = hypoplastic type = celiac disease is diagnosed with this type!
Differentiation of celiac disease from other clinical pictures
1. the autoimmune disease celiac disease 2. the wheat allergy 3. Gluten or wheat sensitivity
Concomitant diseases are e.g. Duhring's herpetiform dermatitis, lactose intolerance, osteoporosis, type 1 diabetes mellitus & malignancy.
Classification of your weight - definition and classification of weight in relation to height.
Special percentile curves apply to children and adolescents; the BMI cannot simply be used here.
BMI and interpretation: BMI: body mass index. Formula: Body weight in kg : (body height in m) 2
Underweight: <18.5, children: <25th percentile
Normal weight: 18.5 - 24.9
Overweight = pre-obesity: 25-29.9
Obesity grade I: 30 - 34.9
Obesity grade II: 35-39.9
Obesity grade III:> 40 = per magna
Which foods are gluten-free and contain gluten?
Where is there a risk of contamination from toasters, cutlery, cutting boards, bread baskets, etc.
What do I have to consider with cosmetic products and medication?
What do I have to consider when baking / cooking in the kitchen / storing food?
in which foods is gluten hidden?
How can I check the ingredients list for gluten?
How are industrial warnings ("may contain traces of") to be interpreted? (Labeling of food)
How often should I have my blood checked / have a medical check-up?
what other precautions should be taken?
What do I have to consider when staying in a clinic, traveling, flying or visiting a restaurant?
Anti-inflammatory nutrition as a basis, individually tailored to you
Holistic therapy - do you have any comorbidities that need to be taken into account during the consultation?
Overall fat selection, how should it be designed
How many animal foods (e.g. meat products, milk and dairy products, cheese, fish products, eggs) are recommended?
What do I have to look out for when choosing animal foods?
How can I counteract inflammatory processes through diet?
Body weight: Weight reduction is recommended if you are overweight / obese.
In the case of insulin resistance and lipid metabolism disorders, also treat them with nutritional therapy
Avoid micronutrient deficiencies and mineral deficiencies & possibly counteract them with nutrient preparations
Prevent protein deficiency
Which nutrients do I need in which ratio?
Get enough fiber (> 30 g / day) through natural foods, possibly fiber substitution
Sufficient fluid: total fluid per day: 30 - 35 ml per kg body weight and day. Attention, this is not just a drinking liquid. The liquid from food (approx. 500 - 800 ml) must still be subtracted from this, so that an amount of approx. 1.3 - 2 l of drinking liquid is created.
add valuable anti-carcinogenic (anti-cancer) secondary plant substances
A selection of foods tailored to your needs with cooking and technical information (for breakfast, snacks, lunch, dinner)
Do you like to eat your warm meal in the evening? I am happy to cater to your individual situation and we will create a plan on how you can implement your wholesome diet into your everyday life.
which oils are good for me? What should I watch out for in relation to the anti-inflammatory diet?
How much fat spread (butter / margarine / vegetable fat) can I use and which products are recommended?
Get enough Omgea-3 fatty acids and essential fatty acids
How can I boost and support my metabolism with natural foods?
Coordinate sensible meal frequency for your individual case - meal allocation
Define the desired weight stabilization / normalization & the estimated period for this
what should be considered with beverages and alcoholic beverages?
How does exercise affect your body and thus also your diet?
Avoid blood sugar fluctuations
Sweetening foods - sweeteners, glucose, fructose, sugar and sugar substitutes, what can I use and in what quantities? How high is the respective sweetness of the different products?
what should be considered when baking and cooking?
what are cheap snacks / main meals
Eating out - what should you watch out for?
Vacation, boat trip or hospital stay, what should be considered?
Flatulence, bloating, diarrhea, constipation, vomiting, heartburn, loss of appetite, pain related to eating, what can I do about it?
Daily plans as an example for practical implementation in everyday life
Optimizing your eating situation
long-term maintenance of a jointly defined weight
Strengthen the stomach and intestines with natural foods
Additional therapy options
Dietetic products in support of nutritional therapy
Food supplements - under certain circumstances, a supplement can be useful
and other topics
Any questions? I look forward to your call or email. To contact form