Beyond Dry Eyes: Unraveling the Gut-Sjogren's Connection
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Kara Wada, MD: Welcome back everyone to this episode of the Becoming Immune Confident podcast. Dr. Kara here and as you know, we love welcoming amazing other health care professionals, members of the inflammatory community to the podcast. And I am just thrilled because we are like long overdue for having Cristina on. You guys are going to learn so much from her. She's such an incredible resource and just wealth of knowledge. Cristina Montoya is a registered dietitian and she is the founder of Arthritis Dietitian. She's also someone who's been living with Sjogren's and Rheumatoid Arthritis for over 20 years, which is hard to believe because she doesn't look much older than 20.
She specializes in helping women with Sjogren's and RA, adopt a non-restrictive anti inflammatory lifestyle while supporting their gut health. She actively participates in Sjogren's advocacy groups and is a frequent collaborator with the Arthritis Society of Canada and the Sjogren's Society of Canada to develop resources related to arthritis and nutrition for their websites.
I am just thrilled to have you on. I'm thrilled to be chatting because I learn so much when we connect. Thank you.
Cristina Montoya: Thank you so much for having me. You know, I enjoy your podcast and all the resources you're putting up. So thank you so much.
Kara Wada, MD: You've been living with Sjogren's and RA for many years. Can you share a little, you know, take us back a little bit and share how those conditions initially affected your life and maybe share a little bit more about your story because I imagine there's a number of listeners who maybe don't currently follow you and don't know you're amazing story.
Cristina Montoya: Well, I will share with you. I recently wrote a blog post for Take a Pain Check called, "When a Child Doesn't Cry, Don't Turn a Blind Eye." And that was meaningful to me because my story started when I was a child, especially with Sjogren's, when no one really knew what that disease was about.
But I, technically had no tears, had no saliva, had difficulty swallowing, fatigue, difficulty to keep up with my peers, just as a young age of 8 years old. So for many years, up until I was 21, my mom really tried to get answers, but no one had them. And so, it was just not a journey, it's not just my journey, but it was my mother's journey. She was a single mom, and working so hard that she wasn't even living with me.
So imagine it was a very difficult time for us, even in Colombia, in the midst of violence. So sometimes we couldn't even make it to the appointments because there was a bombing or something happening in Medellin. So it was quite a journey.
But thankfully by the time I was 21 and I was, that's when rheumatoid arthritis woke up. And this is where I learned that at some point when Sjogren's syndrome was labeled as a primary Sjogren's and a secondary Sjogren's. And even though my Sjogren's presented first, the doctors still labeled secondary Sjogren's after they diagnosed me with rheumatoid arthritis. So of course, they found out I have Sjogren's. But that was the end of it. They had no treatment for it. They had no options. That was in 2003. So that was over 20 years ago.
And so, all my treatments were focused on my rheumatoid arthritis, which was also severe. I developed joint deformities as I didn't have access to the novel therapies at the time. And they weren't very well known anyway, so the rheumatologist didn't feel very confident to prescribe the biologics that we have available now.
So my journey on top of that, when I was diagnosed with rheumatoid arthritis and Sjogren's, I was in the middle of completing my nutrition and dietetics degree in Colombia. When I was with my internship, my clinical internship, my first patient was a 33 year old woman diagnosed with end stage lupus nephritis. When I entered that room, this woman was in tears saying, "I'm leaving alone my three year old, my five year old." And I still remember, and it gives me goosebumps. I ran away from that room. I started crying, bawling at my instructors, like, "What's happening?" Because I didn't know what was going on. And still, it impacted me that how severe these autoimmune diseases could be. I look back 20 years and it's still a roller coaster. Sometimes when you feel that you have everything under control, it's like, "Hey, I got all the pieces together. I get it. I'm thriving." And you don't even think about the pain or disease. And then something out of nowhere could be a stress, disease, an infection, boom, it throws you off again.
Kara Wada, MD: I think so much of my own journey over the last few years really for me has been learning to navigate that rollercoaster and trying to let go as best I can. You know, from moment to moment that that feeling like something's gonna, you know, something's gonna give, something's gonna break, that she's gonna drop, and just kind of letting, like, we can't predict the future.
Cristina Montoya: No, we can't.
Kara Wada, MD: Yeah.
Cristina Montoya: It's definitely hard. And when people ask me, "Oh, did you decide to be a dietitian because you wanted to treat your condition?" I said, No, I decided to be a dietitian because coincidentally around that time I was living with a eating disorder. And you know what I wanted to be? I wanted to be the best at that eating disorder.
Do you feel like how distorted my thinking was? But it was all the opposite. I had wonderful instructors who actually picked out my eating disorder and they helped me and they put me through psychotherapy. They counseled me and it's like nutrition is all about nourishment. It's not about restriction. So even from my early days when I was studying nutrition in Colombia, that stuck with me. The fact of restricting because it was harmful. It was harming me. I was losing weight. I was losing friends, connections, everything because of the eating disorder. And then surprisingly during that time, that's when I was diagnosed with rheumatoid arthritis and sjogren's.
I have a visitor and I'm so sorry.
Kara Wada, MD: Hello. For those that aren't watching, Christina's son has come to say hi. Let's get some snuggles.
Cristina Montoya: He's sick. He's a little sick today. Okay, you want to stay here with me? All right. Yeah, so I'm going back to my story. Yes, so I said that ironically being diagnosed with my autoimmune diseases also helped me recover from my eating disorder because it helped me realize, "Hey, I need to nourish my body. I need to move. I need my energy." So then I took my nutrition and knowledge, like seriously, to help me cope with what's coming.
Kara Wada, MD: and it really sounds like, you know, kind of hearing your story from the outside perspective that there was this shift from, you know, to really loving yourself in all those ways, the love and nourishment.
You know, there's a lot of discussion and maybe this is a good segue kind of into this idea, you know, gut health is kind of like the topic, and the headlines all over.
But it really is especially crucial for those of us who have autoimmune conditions and you know we're learning more about its role maybe in the development of these conditions, but how does Sjogren's in particular specifically impact the gut and our nutrition?
Cristina Montoya: I will first share that story and how when I figure out that Sjogren's was the culprit of my gut health issues. When I came to Canada in 2008, maybe because of the changes in culture, food, everything else, I had about supposedly irritable bowel syndrome. That's what I was diagnosed with. For about a year, I was told me I could not swallow anything solid. I was living off supplements, nutritional supplements, like Ensure and crackers. I went to the gastroenterologist, they ran all the tests. Of course, they all came out normal and they said, "Well, you only have Irritable Bowel Syndrome. Go home. There's nothing wrong with you." So at that time, about around 2008, just for my own knowledge, that's when all this intervention about the low FODMAP diet, started to emerge. So that's when the Monash University, there was some dietitians who came to do a presentation here in Toronto and they shared some of the knowledge about their research that they were doing about the low FODMAP diet, which is are those like fermentable carbohydrates that they got not able to tolerate.
And I thought, "Huh that is quite fascinating." And, but there was no evidence, right? There's new. It is what it is.
And to me, it was a restrictive and elimination diet, which was all against my principles. And so I didn't really pay attention to it. So I think before I was a dietitian, I actually give it a try. I think like maybe around 2012, 2015, I decided to finally give it that low FODMAP diet a try and it worked. It really helped to help me manage those, maybe I did have, at some point, irritable bowel syndrome 'cause I did have some symptoms like abdominal pain, a mix of constipation and diarrhea. And somehow I was able to identify my triggers by implementing this low FODMAP diet.
But then I also realized that it could be very restrictive and it can also fear. I had some food aversion for almost two or three years. But then I was so fearful of really introducing foods. And I said, "Okay, this is fine." But I, to be honest, about maybe three or four years ago, I started to look deeper into that connection and I said, is it just Irritable Bowel Syndrome that I'm feeling because I can't swallow. I still have to avoid many foods, not because they upset my stomach, because I can't swallow. Sometimes the food just doesn't go down. It stays in my stomach for a long period of time.
And of course, the dryness is so unbearable sometimes. But it also affects the foods that you eat. I finally started to figure out, "Hey, sjogren's can also manifest in gastrointestinal symptoms that can affect from gum to bum. Right?
Kara Wada, MD: That is a much cuter way of putting that than the other ways I've heard that concept, um, described.
Cristina Montoya: It is. It can make any part of your gastrointestinal tract from gum to bum. Literally.
Kara Wada, MD: Thank you so much for listening to this episode of Becoming Immune Confident. We have just scratched the surface of Cristina's incredible knowledge and insights. Be sure to join us next time, as we dive deeper into practical strategies for thriving with Sjogren's. Especially when it comes to gut health and nutrition.
But before we go, I am thrilled to share some exciting news with you. Registration is now open for the
3rd Annual Virtual Sjogren's Summit: Gut Instincts for Sjogren's,
hosted by Christina and I. If you're ready to take charge of your gut health to feel your best with Sjogren's, this summit is for you.
We'll have amazing speakers, expert advice, and a supportive community. Head over to sjogrenssumit.com to learn more and to sign up. Trust me, your gut will thank you. See you again next week.
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