When the nurse described the procedure I was about to undergo, she told me I would be sedated. She took off her reading glasses, looked me in the eyes, and gave it to me straight: a technician would insert a 3-foot tube with a camera into my anus and up the rectum, where it would traverse the hairpin curves of my colon. She stared at me in disbelief when I asked to remain lucid so I could watch the camera snake through me. As she scribbled in my chart, I watched the tail of a Felix the Cat clock swing back and forth for a good two minutes before she agreed to administer only a half-dose of sedative.
The hardest part turned out to be holding the pose. While lying on my left side in a freezing surgical suite, I had to bring my right leg up to my chest and make an awkward three-quarter neck twist to view a monitor behind my head. I felt like a roofied Nadia Comaneci, desperate for cash, making an adult movie she’d later regret.
I was no stranger to colonoscopies. This was my third in a decade. I’ve been a dining critic for 18 years. The job presents certain gastrointestinal hazards. When I tell people what I do for a living, they often say they wish they had my job. It does sound glorious. I get paid to eat at new restaurants, enjoying rich, decadent food, wine, and cocktails. The job is a privilege, and it certainly has brilliant moments. But the truth is that dining critics eat more average and subpar meals than exquisite ones. For me, the work produced stomach cramps, gas, acid reflux, bloating, and diarrhea. Lots of diarrhea.
It often felt as if snakes were trying to bite their way out of my bowels. Other times, my stomach felt like I’d swallowed fire ants. My first colonoscopy was scheduled after I told my gastroenterologist, “Two porcupines were playing soccer in my intestines, and they died.” After another colonoscopy indicated nothing serious, I accepted pain and humiliation as part of my life.
I worked at home because it was a shorter dash to the toilet; I’d had too many accidents at the office. I had to run out of editorial meetings, dining rooms, and interviews because I’d soiled my clothes. When things got really bad, I wore Depends. As a 62-year-old woman, I can’t tell you how delightful it was to type that last sentence.
But things went from bad to worse recently, so back to the gastroenterologist I went for that third exploration of my innards. Days later, I met with the doc to go over the results. They were normal. No obstructions, lesions, celiac sprue, or giardiasis. He told me I suffered from irritable bowel syndrome and that I should eat a high-fiber diet and get some exercise. I walked out of his office thousands of dollars poorer and more convinced than ever that most doctors aren’t to be trusted. I knew something was wrong.
After my mother died, in July 2012, my unhealthy eating habits only worsened. I never ate breakfast, and lunch often consisted of a frozen low-calorie meal from a cardboard box. I saved my caloric intake for reviewing restaurants. I was constantly exhausted. But I convinced myself that the seemingly endless sporting events taking place in my gut were promoted by anxiety over deadlines, the death of my dog, cynicism over world politics, and my slow-growing 401(k).
By the beginning of summer 2013, I’d fallen into a wretched pattern. I was tired, groggy, and forgetful all day and awake and alert most of the night. Some days, I could pull off eight hours working in the office and four more eating at a restaurant. Other times, though, I would be typing away, and my mind would call it quits. Thinking of a Rangers game halted by a summer storm, I imagined tiny groundskeepers in my brain rushing across my cortex to cover it with a tarp. Twice I had to pull my car over because I was too dizzy and weary to drive. I gazed at joggers and wondered how they made their feet move so fast.
One night, my left leg started twitching like someone had hooked jumper cables to my calf. I used to laugh at television ads for restless legs syndrome. I categorized that condition with the hokey holidays (Sweetest Day!) Hallmark made up to sell cards. I figured the ads for RLS were designed by big drug companies to sell pills. I bought pills all right, but they weren’t for RLS. I popped Ambien like Pez.
For a year, I lived in a state of confusion. I was too tough to give in to an upset stomach and some annoying diarrhea. While several “ologists” have scolded me over the years for waiting so long to see them, I’ve always viewed my tolerance for pain as a badge of courage. In 1994, my gynecologist, Dr. Jan Goss, read the results of an ultrasound that indicated endometriosis on my left ovary. She looked at me and shook her head in disbelief. “I have patients with less pathology in their pelvis than this, and they are in bed and on painkillers,” she said. “How is it that you are still walking around?” Dr. Goss removed my left ovary one summer and took out the rest of my reproductive system less than a year later. No big deal. I recovered by watching Wimbledon in the morning and the O.J. Simpson murder trial in the afternoon.
Dr. Goss was one of the few doctors I trusted. She was easy to talk to and actually treated me with care. She made follow-up calls to see how I was feeling. Even though she was a gynecologist, I saw her for all my minor medical needs.
So on the morning of November 11, 2013, when I realized something terrible was happening, I instinctively called her office. I’d woken up and been unable to move my body. It felt heavy, yet hollow. A migraine had my head in a vise. My vision was blurred.
The receptionist answered the phone. “I have to come in today and get some blood work done,” I said. “I think I’m about to die.”
My life changed the next day when Dr. Goss called with the results. She told me I had hypothyroidism and severe vitamin D deficiency. My underactive thyroid was barely producing hormones. Dr. Goss prescribed a daily dose of 88 milligrams of Levothyroxine, a hormone replacement, and a once-a-week dose of 50,000 units of vitamin D. I left her office and drove to mine.
Before I’d even gotten the prescription filled, I felt better. It was such a relief to know that I wasn’t delusional. I had an actual medical problem! There was an explanation for what had been ailing me, and I knew what to do about it. I was just a pill a day away from a new life without diarrhea.
Then I dove into the internet to learn about the thyroid, a gland in the front of the neck, just below the Adam’s apple. To function properly, the thyroid depends on TSH (thyroid-stimulating hormone), which is made by the pituitary gland, the “master gland.” It’s about the size of a pea and sits at the base of the brain. When your thyroid fails to perform, bodily functions—sleeping, thinking—start to shut down.
A couple months after my diagnosis, though, my optimism began to fade. My brain was still hazy, and my sleep pattern hadn’t improved. I was anxious (more than usual) and irritable. My vision was blurry, and clumps of hair fell to my feet in the shower. I couldn’t lie on my side, because my racing heart pounded against my chest.
I returned to Dr. Goss for a checkup. She called the next day to tell me I was now suffering from hyperthyroidism—the gland was now in overdrive. Obviously the 88 milligrams of Levothyroxine were too much. She called in a prescription for a lower dose, but not before she mentioned that even though my vitamin D level had risen, it was still low.
Then my sister, Amy, stuck her nose into my business.
She had been doing research to solve her 14-year-old daughter’s gastrointestinal issues. Her daughter complained of stomach pain, constipation, lethargy, acid reflux, and weight loss. Amy spent thousands of dollars on tests and surgical procedures, all of which turned up nothing. The final diagnosis: IBS. She was sent home with a prescription for acid suppressants and told to eat a high-fiber diet. My sister was convinced the doctors were wrong and that her daughter’s enemy was gluten, a protein found in grains such as wheat, rye, and barley. Gluten causes inflammation in the intestines of people with celiac disease.
My niece had tested negative for celiac, but Amy didn’t care. She came up with a new life plan for her daughter. She helped her do a gut cleanse and eliminate gluten from her diet for two weeks. Then she gave her daughter gluten again, and—bam—she got sick.
“You have to get gluten and processed foods out of your diet,” Amy told me. “It’s killing you.” She blabbed on and on about how I needed to cleanse my gut so that it could absorb nutrients and medication. “You’re just peeing all of that money away,” she said.
I was happy for my niece, but listening to Amy was like being trapped in an elevator with a Hare Krishna. She was overly zealous, and I just wanted to move along. Besides, I was the older sister, and I’d lived through the decades when fat and carbohydrates had been vilified. Too many people were now going gluten-free just to lose weight. This, too, shall pass, I thought.
“I’m happy it worked out for you guys,” I told Amy. “But there is no room for a clean gut in food writing.”
In late july of last year, I received a letter from Dr. Goss’ office informing me that she was retiring. I made an appointment to say goodbye and—why not?—had some blood drawn while I was there. On her last day at work, Dr. Goss called to tell me my numbers were bad. My system had switched back to hypothyroidism, and my vitamin D level had dropped again. I’d been bouncing back and forth for almost a year.
She referred me to an endocrinologist. When I called Dr. Audrey Miklius’ office, I was told I’d have to wait three months for an appointment. The scheduler promised to call if an appointment became available.
At this point, I was beyond desperate, so I swallowed my pride and called my sister. “Can you send me some of the gluten links you found helpful?” I asked. “I can’t live like this anymore.”
I couldn’t actually stop eating gluten, because that would throw off my baseline blood work when I finally got to see the endocrinologist. So instead I just read about it. I devoured everything from “Beat Bloat!” and “Gluten Solution!” listicles to Dr. Oz to clinical studies. I visited Eastern and Western medical sites and studied leaky gut, brain fog, irritable bowel, gluten intolerance, gluten sensitivity, thyroid autoimmune diseases—anything that remotely applied to my situation.
Doctors hate it when patients try to get a medical degree from the internet. There’s so much pseudoscience and misinformation just a click away. But I figured I’d be lucky to get 20 minutes with this endocrinologist, and I wanted to be prepared to ask informed questions. Amy warned me that a Western doctor probably wouldn’t even bring up gluten during a consult. The more I read, the more I came to believe that gluten really might be the problem. That’s what scared me. A dining critic who can’t stomach gluten? It sounds like a bad joke. Maybe I could form a support group with a blind movie critic and an aquaphobic swim instructor.
Fearing I might lose my job, I kept my suspicions to myself as I faced one of the most challenging eating periods of my year. For D Magazine’s December issue, in which I name the best restaurants of the year, I essentially do breakfast, lunch, and dinner at more than a dozen restaurants over a two-week period in October. I was making dinner reservations when the call came from Dr. Miklius’ office. There had been a cancellation.
I went prepared, with copies of all of my past blood scans and gastrointestinal reports, and regaled her with the epic poem that I’d memorized about my bowels and everything else on me that seemed broken. My vitamin D deficiency score was one of the lowest Dr. Miklius had ever seen. She was a good listener, but when I told her what I did for a living, she laughed. “I have a job that makes me sick,” I said. “Can you write me a note for disability pay?”
Dr. Miklius put her hand on my thyroid. “It’s definitely bosselated,” she said, meaning covered with bumps. “Have you ever thought about eliminating gluten from your diet? I’m going to test you for celiac. But even if you test negative, you need to get your gut healthy and free of gluten, because it’s all about the gut.”
“No treble? Just gut?” I said. My Meghan Trainor joke fell flat. The doctor just stared at me.
Ignoring my attempt at levity, Dr. Miklius started the conversation I’d been avoiding for more than two years. “It doesn’t matter what you do for a living,” she told me. “If not eating gluten makes you feel better, you need to consider your health and risk feeling better.”
In addition to suggesting I eliminate gluten from my diet, Dr. Miklius also upped my Levothyroxine and weekly vitamin D dosages. She preached patience, of which I have very little, and detailed the schedule for my treatment. In two months, I would see a nurse practitioner. Two months after that, I would report for lab work. I wouldn’t see her again for six months.
Not long after that visit, I received an email (nobody calls anymore) stating that my celiac panel was negative, meaning that I could pretend gluten wasn’t the problem and forge ahead with my dining plans. By mid-October, though, my stomach looked like I’d swallowed a football and the tip was pushing against my belly button. One night, after eating almost the whole menu at Blind Butcher, my friends and I walked down Greenville Avenue to Carnival Barker’s Ice Creams. Then I said goodbye and headed north on Central Expressway. By the time I reached NorthPark, my stomach was boiling. A few exits later, despite my best efforts, a terrible thing happened. I threw my jeans in an alley trash can when I got home.
Dining out had developed into a form of torture. I stopped looking forward to eating and hated the job I feared losing. So when I finished my work for the December issue, I decided to make some changes. I couldn’t wait another two months to see a nurse practitioner in Dr. Miklius’ office.
In doing research on the internet, I’d read a lot about functional medicine, a growing movement that focuses on the whole person, not just an isolated symptom. Nutrition plays a big role. A friend of mine who is a dietitian recommended a functional medicine practitioner, and a week later, I stepped into the small office of Susan Linke, a medical nutrition therapist with a long list of postnominal titles—MS, RD, LD, CLT. We sat at a round, dark-wood table in the middle of her office, and I fanned copies of my medical records in front of her. She ran her fingers through her black, shoulder-length hair as she studied the numbers. Then she broke the silence: “This is the second-lowest vitamin D level I’ve ever seen. The woman with the lowest level couldn’t walk.”
For the next two hours, I spilled my guts to her. Inevitably the conversation turned to gluten. “Gluten sensitivity can lead to leaky gut syndrome, which can lead to autoimmune conditions like Hashimoto’s thyroiditis,” Linke said. A so-called leaky gut doesn’t absorb nutrients. And unlike hyper- or hypothyroidism, Hashimoto’s is an autoimmune disorder in which the immune system misidentifies the thyroid as a foreign body and tries to destroy it. “Even if you test negative for celiac, if you are gluten-sensitive or gluten-intolerant, you experience some of the same responses. Everybody’s body reacts differently, which makes the whole puzzle so complicated. It takes trial and error, taking all things out of the diet and re-introducing them, to get answers.”
She suggested I do a gut cleanse and add magnesium, zinc, and vitamin K2 to each dose of vitamin D. “Your vitamins and minerals don’t get absorbed by themselves. They all work together,” she said. “You could end up with a magnesium deficiency and start having leg cramps and restless leg symptoms.”
I hadn’t told her about my leg cramps. It felt a little like a fortune teller had just guessed the name of my last boyfriend. When she handed me a bill for $90, I was stunned. Could I trust such inexpensive information?
On October 15, 2014, I started a gut cleanse and cut gluten from my diet. I didn’t buy any of the countless 21-day programs on the market. Instead, I invested $99 in a NutriBullet juicer and took the lazy, most expensive dining road. Every three days, I bought fresh, prepacked, gluten-free meals at Snap Kitchen. I didn’t have time to train myself to cook. At this point, spending $30 a day seemed like a bargain. Every morning, I blended greens, vegetables, fruits, nuts, and seeds in a shake I now lovingly refer to as pond scum. Within a week, the diarrhea disappeared.
The coming weeks brought more improvements. I felt better and had more energy. I noticed a bounce in my step; I felt lighter. The football in my stomach deflated. Patches of psoriasis on my elbows and hands disappeared. The joints on my hands, riddled with osteoarthritis, were no longer swollen. Without realizing it, I was putting on makeup and wearing clothes other than sweats to the office. I was excited to go out to dine, even if I couldn’t eat most of what was on the menu. I got so chatty at the office that my editor said he was going to develop a gluten tranquilizer dart to calm me down.
Given that I’d tested negative for celiac, I became convinced that Hashimoto’s was the culprit. The condition can be diagnosed with a blood test called a TPO antibody test, which I eventually got. But it wasn’t easy. The first time I asked for the test, a nurse wouldn’t do it, saying she needed orders from a doctor. At the time, Dr. Miklius wasn’t available to give those orders, and I had to return a week later and plead my case to a nurse practitioner.
On December 2, I received an email with the results of that test. Dr. Miklius wrote: “Nancy, you have anti-thyroid antibodies. We see these in Hashimoto’s patients. Sometimes they go away over time. Take care.”
I’ve decided to take my doctor’s career advice. After 18 years of eating to make my living, I am going to put my health above my job. Instead of eating food to write copy, I’m now using it to heal my wounded thyroid.
Most people get into the restaurant business because they want to make people happy. I loved the years I spent cooking in a restaurant kitchen. It’s fulfilling when people love what you feed them. It’s equally satisfying to have a healthy discourse with food lovers and restaurant owners, whether on our blog or in the pages of the magazine. I’ve been blessed with the opportunity to embrace both sides of the business and fortunate to work for a company that allows a person to take on new challenges. When I started at D Magazine those many years ago, I worked in marketing. Only somewhat accidentally did I stumble into the role of dining critic. That role now must necessarily change. I’ll still write about the restaurant industry, but I can no longer serve as our lead critic of what those restaurants put on the plate.
I’ve gone four months without gluten. It’s not that difficult once you get the swing of it, but when you dine out, you have to ask questions. I never thought I’d be the obnoxious person at dinner who bugs the waiter about what’s in the sauce. I was always the girl who was impatient with people who wanted to know if there was cream in the soup (so what!), gluten in the pizza (moron!), or if the grass-fed animal was clubbed humanely over the head (paleo punks!). I believed lactose-intolerant sissies should take their meds and pass me the artisanal ice cream.
Now I am that picky diner with too many questions. Please be patient with me. I’m just trying to make it home without ruining my pants.