November 29, 2017

Quarter Life Crisis - I Have a Gluten Allergy




Adult Onset Allergies


This happens to people all the time. I know it does. It happened to my dad when he became lactose intolerant in his mid-twenties (albeit this was following some very serious medication to dispel a "sushi parasite"). And yet I really didn't think that it would ever happen to me. That I would become allergic to anything, that is, after living most of my life allergy free. Well...it did. I developed a gluten allergy, probably at 25, that I didn't manage to properly identify until 29.

First Flare-up

The first indication that something was terribly wrong, something that had likely never been wrong before, was when I started having terrible adult acne at the age of 25. As a woman if you start to develop acne in your mid-twenties hormones are immediately blamed, and this was no exception. This wasn't a pimple or two around my period. These were huge, painful, cystic pimples, and at one point I was literally getting a pimple per day. Think about that. Over the course of one month I would have had 30. On top of that I have hyper-pigmentation, so even if I only got one pimple, that scar would be evident for about two months. The result was that for about a year my face always hurt, I was unbelievably and constantly stressed, and for the first time in my life I never left the house without makeup. Even after the crisis was averted it still took upwards of three months before I felt comfortable skipping foundation.

Detection Evaded 

Acne was not the only symptom of my gluten intolerance, but because it was the most severe and inconvenient, it was the only one I noticed. I'd been getting migraines since I was eight years old and was taught long ago that MSG was the devil. I avoided processed food for this reason, ate balanced meals and took supplements. It never occurred to me that something in my diet might be wrong. This led to my completely missing what should have been an obvious connection between my acne and another skin related issue that would have indicated an allergy.

Again, because people immediately associate acne with hormones, everyone and their mother (literally) gave me advice as to how to balance my hormones that had suddenly gone crazy at 25. Get off birth control, they told me. Oh? I wasn't on it? Then get on birth control. Stop eating meat - the food industry is such a mess these days, bla bla bla. Oh, and also stop eating dairy, because goodness knows the livestock that dairy comes from is pumped full of hormones. That's definitely what caused this drastic shift in my body chemistry, even though I've been living in the same country my entire life and eating the same foods from the same food industry and, if anything, have gotten more conscious of what I put in my body over the years and currently ate all organic, hormone and cage free. But yeah...go vegan!

From my sardonic tone you may have gathered that essentially going vegan yielded absolutely no results. Meanwhile I completely missed the connection between my acne and the fact that I suddenly now broke out inexplicably in hives - mostly on my neck, back, arms and stomach - for about 30 min at a time. Reason, also, unknown.

Medication

At one point, pretty much right before I broke down and went to a dermatologist, someone at my Pilates studio thought it might be a gluten allergy. By then, however, I was spent. I'd been a begrudging vegan for months, I'd tried oil cleansing, abandoned the oil cleanse method and returned to the acne face-wash of my teens, all to no avail. I was very anti-medication, as it treated the symptoms, not the cause, but I was tired of being in pain, tired of looking scary without makeup, and tired of stressing over every little thing I ate or touched only to wake up to another painful cyst every morning. My dermatologist tried three different topical medications with me but there was no change. Finally we bit the bullet and she prescribed a generic version of Accutane.

If you haven't heard of it, Accutane is basically the nuclear option if you have acne. It mimics a vitamin A overdose, which in addition to clear skin also results in very dry lips, nosebleeds (due to dryness) and worst of all, terrible birth defects if one gets pregnant within a month of being on this medication. In order to be prescribed one must sign a pledge that is reported to the government promising to use two forms of birth control while taking this medication, and get blood tests once a month to ensure one is not pregnant.

Well, I pledged, and after just two months my skin was mostly clear and my scars were fading fast. I took my medication diligently and reverted back to my meat and dairy eating ways. My doctor started to ween me off of the medication. From twice a day down to once a day, then from every day down to every other day. Finally I was finishing my last pack, acne free with only a sheer coat of BB Cream needed to cover any lingering scars.

The irony is that during my brief sabbatical from meat and dairy, I was eating more gluten than ever before. I've never been a huge fan of bread, so avoiding hot dogs and burgers hadn't been difficult, but a lot of the carbs I loved that were gluten free didn't seem like they constituted full meals to me. Things I normally ate with meat - rice, potatoes, etc. - got sidelined for the much more attractive all-in-one option: pasta. Once my sabbatical was over I went back to my usual meals, my beloved mashed potatoes, and had pasta/pizza at least twice a week. The Accutane was still hard at work and masked the effect it was having on my face, though it did nothing to ease the sudden hive-condition I apparently had.

When I mentioned it to my dermatologist, showing her a photo of my shoulder in which it looked like I'd been scratched by a feral racoon, I explained that though they often looked like scratches they were just hives, and that they itched mildly and usually disappeared within half an hour. If I scratched them, of course, they lasted longer and spread to a larger area. She nodded knowingly. She said that it was definitely an allergy, though she couldn't immediately tell me what I was reacting to. It was probably a reaction to something external she told me, like dust, or even just irritability. I noted that sometimes if I touched something rough - like if I carried an Amazon box inside and my skin brushed the cardboard - the hives would appear in exactly the place that I'd touched. A Benadryl a day should alleviate the issue, she told me, but it wasn't enough of an issue to warrant another daily dosage of medication as far as I was concerned.

Meanwhile, with my mind finally at ease regarding my face I was free to notice a new problem that was unfamiliar to me. I'd never considered myself a particularly gassy human being, but recent months were making me wonder about that fact. It was getting to the point that I was actually becoming self conscious when watching TV with my boyfriend (at the time) because there were moments where I swore my stomach was louder than the speakers. A week or so before my planned trip to Paris, I began researching IBS, IBD, Chrone's, and all sorts of sad stomach conditions I really hoped I didn't have.

Paris

I was two weeks into my stay in Paris when I realized with a jolt that I hadn't been doing my IBS research. I hadn't been doing it because I hadn't been thinking about it, and I hadn't been thinking about it because my stomach was absolutely fine. No gas, no discomfort in an attempt to avoid gas, no digestive operas being sung from my intestines after a meal. I was absolutely back to normal.

When I returned to NY I noticed that my tummy tantrums did gradually return. Indeed, I credited my temporary healing to the wrong thing. I credited it to the food being fresher in Paris, less processed "crap", etc. But there, again, was the lazy blanket argument that failed to take my current behaviors into account. While I had returned to meat and dairy, I was already eating organic at home and still diligently avoiding hormones in animal products. The difference was that in Paris I didn't have to go out of my way and pay an arm and a leg to eat well, but that didn't change the fact that, whether at home or abroad, I was eating well.

What had changed, then, you ask? Remember, I'm not a bread person. I never have been. The only - and I mean the only! - downside to Paris was breakfast. I am very American in that regard. Eggs, homefries and bacon all the way, thank you very much. I was very confused when I was offered cake for breakfast, and muffins, and pastries, and all sorts of baked goods that belonged in the dessert category if you asked me. I found ways around that. My hotel provided scrambled eggs, and I located one faithful cafe that always had poached or hard boiled eggs on hand.

I think I had pasta exactly twice the entire time I was in Paris. Otherwise I was having fish, lamb, rabbit, duck, poached eggs in mushroom bisque, foie gras, pate, etc. I didn't even have crepes as most places I found only offered dessert crepes, and I'm more of a savory person. I hadn't avoided gluten on purpose. It just happened. Had I decided to visit Italy I probably would have had a very different experience. In any case, in Paris I had no acne, no hives, and no tummy tantrums to speak of.


Relapse 

About a year ago, a year and a half after Paris, two years after Accutane, I noticed that I was breaking out again.  It wasn't anywhere near as severe as it had been when I reluctantly decided to nuke my system, but it was enough to cause alarm. Knowing the benefits of vitamin A, I started adding one tablet a day to my supplement regimen . I added in cod liver oil as well, doubling up on my capsules if it seemed that I was having a flare-up. There was no doubt that upping my vitamin A intake helped to keep my skin relatively clear. Still, I knew that the underlying cause had never been properly addressed, and that essentially dosing myself whenever I found a blemish was not a sustainable solution. What's more is that even with my strategic self medicating I was still having flare-ups every now and then that were bad enough to cause me to up the dosage, if only for a few days.

Paleo

For reasons completely unrelated to my skin I decided to go Paleo for three months directly following my birthday. Though the traditional route would have allowed for certain carbs, I referred to an app that restricted me to only foods that were mostly made up of protein and fat. Even quinoa didn't pass the test. The intent had been to cut out gluten and glucose for a spell to see if it would have a stabilizing effect on my moods (because you won't like me when I'm hangry). To my surprise, two weeks into my 90 days of Paleo I suddenly had clear skin.

It wasn't only the annoying breakouts I'd been keeping at bay with my cod liver oil and vitamin A combo that started to disappear only 14 days into Paleo. There were little bumps that had started to become background noise to me hanging out all over my forehead and chin. They weren't blemishes per se, and I barely even noticed them...that is until they were gone. My skin hadn't been so clear and smooth since the months immediately following my Accutane nuke. Except, of course, before 25. Before the whole ordeal had begun.

I knew I'd found the trigger then, and since I was eating more meat, cheese and butter than ever to try to get all my necessarily calories on little to no carbs, the whole "hormone" argument was debunked. Gluten was the only trigger food I could put my finger on. Especially when I realized that, in an effort to avoid gluten and glucose I'd been forsaking beer for wine, much like I had in Paris (although that was more due to the availability of quality wine in cheep bars, unlike dear old NYC).

Skepticism/Cynicism 

"I'm gluten intolerant!" I excitedly declared at a friend's birthday brunch. Right about now that's a pretty kitschy sentence. If I were perusing a Williamsburg market and saw a bottle of water marked "organic, gluten-free" I wouldn't be surprised. There were other factors to consider that could be causing my reaction to "gluten," my friends pointed out, such as how the food was being processed, how much gluten was in it, and a whole host of other things. Still, I was definitely having a reaction to something, and it was odd that all of my symptoms magically disappeared the moment I cut out carbs. I didn't want to be gluten intolerant. Drunken dollar pizza at 2 am was a staple of NYC living that I would no longer be able to partake in if this was the case.

The problem was that over the years since my range of symptoms had appeared, I'd tried way too many things at different times to be absolutely sure of the cause-and-effect I thought I was witnessing. What I needed was a targeted, controlled experiment.


Science

First, all other variables had to be eliminated. I was on birth control. Check. I would stay on and remain diligent to avoid the possibility of "hormonal upset." Second, I had to start eating carbs again. Careful as to not upset my new found glucose balance, I started adding carbs back into my diet. Some potatoes here, some rice there. A little bit of yucca. Gluten-free gnocchi. No undesirable side effects to speak of. Finally, and this was the scariest thing, I started to ween myself off of my cod liver/vitamin A cocktail. Similar to what I'd done with the Accutane, I went from twice a day, to once a day, to every other day, then every couple of days, and once the bottle ran out - ignoring the panic I felt on the inside - I did not replace it.

Still, no acne commeth.


And then my moment came. I was at work. It was potluck day. And someone had brought in an old friend I hadn't seen in a while - baked mac and cheese. If I was going to do this, I had to be scientific about it, so I resolved to try to mac and cheese and nothing else for the rest of the day. I took a nice, big serving and returned to my desk with my water bottle where I happily indulged for the next twenty minutes.

About two hours after I stopped eating I got a familiar feeling. The tummy tantrum was here. This experience was worse than I remembered. I assumed it was either because my body was getting used to going without gluten, or because I was so used to not dealing with midday tummy issues that this was a shock to my system. Either way, there was no question that my body was not happy with my pa-pasta-rous decision. I do not want to disclose how many times I had to quickly leave my desk for the ladies room that day, nor do I wish to disclose how long it took me on each occasion to return. Suffice to say, it was confirmed - I am gluten intolerant. I even got to show my fun little bear scratch hive trick to a coworker when it revisited me after many months on my arm halfway through the day.

And that would have been enough to convince me had the debacle ended there. But alas, true to my experiment I did not take any preventative supplements and, when I awoke the next day, right smack in the middle of my cheek was a huge, painful, cystic pimple. The first of its kind I'd had in months.

It took an entire week and a half to heal and after a very aggressive topical vitamin C treatment it has finally started to fade after 23 days.

Here endith the experiment.

Cure

So okay, I'm gluten intolerant. And you know, it isn't that bad. I've never loved bread anyway, so I don't feel any particular loss when I'm eating a burger wrapped in lettuce, or having pizza whose crust is at flat as the plate I'm eating it off of rather than three inches deep. There is such a thing as gluten-free pasta you know, and so far I haven't been disappointed in anything but the penne. And I was never big on penne anyway. So there.

All in all I think the most annoying thing about my gluten allergy was the four years that it took me to figure out what the hell was going on. It was a quarter-life-crisis to be sure. But now I am cured and optimistic as I approach my 30th year, tummy calm, face clear, bear scratch free.

I just better not become lactose intolerant when I'm 45.

There is such a thing as too much bad luck to give one person, I feel.

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