By Patrick Fratellone, M.D.
The last patient of the day on a cold December evening was Jennifer Esposito. I had never seen her Academy Award–winning film, Crash, but I had seen the popular Friday night show, Blue Bloods. Yet, the woman sitting there in front of me seemed to have no correlation to the vibrant character she played on TV. This woman was distressed, unkempt, and suffering on all levels. Her chief complaint on the intake form read: Overall poor health. She wrote that she suffered from daily headaches with a severity of 7 to 8 on a scale of 10. Under “duration” she had written: For years—getting worse.
When she came to see me, Jennifer had already been diagnosed with celiac disease by biopsy as well as serum blood testing. She had been on a quest to remain 100% gluten free, but she was still having many health issues. She had suffered since childhood, and I wondered, as I listened to her story, how she had survived all these years. Clearly she was determined, and was highly motivated to understand her disease. I could relate to that—I have celiac disease, too, and it took me a long time to get diagnosed. Once I was, I wanted to know everything, just as she did. When I was diagnosed, nobody said anything about diet.
I explained to Jennifer that celiac disease is an autoimmune disease, and is often accompanied by other autoimmune diseases. She might well have some other condition that had yet to be diagnosed. I drew her a diagram of the small intestine that looked like a shag carpet. I explained that this protein, gluten, had flattened that carpet into a Berber rug. The small intestine is essential for the absorption of nutrients, the production of vitamin D3, and crucially, the manufacture of the neurotransmitter, serotonin. When serotonin is low, the body overproduces norepinephrine, which can cause severe anxiety. This process also depresses GABA production, which can cause sleep disturbance.
As I spoke, tears welled in her eyes and then she began to cry. The emotional impact of finally being heard by a doctor was overwhelming to her. We discussed food rotation as a way to take her gluten-free diet and make it even safer for her delicate system. We discussed the “energy thieves” in her life that were making her condition worse—stress, overwork, anxiety. We discussed meditation and prayer. I began to paint a picture of the woman she would become as we wrestled down her celiac disease.
Today, I see a different Jennifer Esposito. She is not without health issues. Managing her disease is her daily duty, but she takes the job very seriously, and it shows. She has reclaimed a vibrancy she once had, and she is living a life that works. She has a purpose, and the energy she needs to fulfill it. She may not get to eat or even feel like someone who doesn’t have celiac disease, but she gets to feel like herself. She is alive, inspired, and is reaching out to help others, through her blog, her bakery, and now, through this book. It has been a beautiful evolution to witness—from darkness, in the place she was when we first met, back into the light of her own purpose and promise.
I am proud and privileged to be part of her life, and to have played a small part in her discovery of her own “new normal.” She has taught me much over the years, which reminds me of the William Osler quote, “Medicine is not taught in the classroom, but at the bedside.” May this book teach you much as well, giving you the insight and the inspiration to take back your own life from the grip of celiac disease and learn how to live again.
—Patrick Fratellone, M.D.