Holy Communion & the Gluten Free Diet

Easter & Christmas are the two times a year that most people go to church even though they don't go the rest of the year. Based on this, it is those two times that I see the most activity of people asking about the safety of different aspects of the gluten-free diet and how it meshes with religion. Communion is quite possibly the most common topic of these questions. (Scroll forward a couple paragraphs if you want to read information rather than a personal story.)

Six years ago, I had been attending a Lutheran church that I liked near my home for several months. I was raised Lutheran, and every church I went to had communion once a month--usually on the 2nd or 3rd Sunday of the month. The first time I went to this church, they served communion, so I made the plan to attend every Sunday except for the Sunday's they served communion so I could avoid the uncomfortableness that went with skipping communion. But then they served it the next Sunday. I assumed one of the two must have been a "special" day I was unaware of due to not going to church for so many years. The third Sunday had me really confused when they served it once again. It was then that I realized they must do it every week. 

Even though it made me uncomfortable, and I wanted to go up to receive communion, I simply sat in my seat while it was being served. Eventually, someone very tactfully inquired as to why I didn't go up after church one Sunday. I explained that I had celiac disease, so I could not consume gluten which meant no communion for me. They quickly assured me that they had gluten-free wafers, so I could take communion. I questioned further, and discovered they put the gluten free wafers in the same cup as the regular wafers, thereby contaminating them. They also served the wine by intinction which means you dip your wafer in the cup of wine, which would contaminate the wine. It was uncomfortable for me, but I explained that I am extremely sensitive, and I couldn't take that risk. 

I continued to simply sit in my seat while communion was served until Easter of that year. At that point, I decided that I would take the risk and take the wafer, but skip the wine. How much could it possibly get contaminated anyway? I felt good about it as I approached the front of the church. I had been instructed to simply say "gluten free" as I approached the pastor so they'd know I needed a gluten free wafer. I watched in horror as the pastor dug to the bottom of the cup for a gluten free wafer. There was no way there wasn't gluten all over it. I must have panicked because in any other circumstances, I would not have consumed something that was almost certainly contaminated. I had no idea what I could do with it, so instead, I put it in my mouth and ate it. I vowed to never take communion if it was a risk again. It was also the first and the last time that I knowingly ate something that would be contaminated. 

That day, I made a large Easter dinner for myself and the guy I was dating because neither of us had family in town. I was scared to death of when the symptoms would hit, but I went forward with the cooking fully aware that I could wind up wasting all of the food. Thankfully, I didn't get sick until after dinner. The guy left shortly after I rushed to the bathroom, and our relationship didn't last much longer after that. I felt incredibly stupid  because I know better, but it was definitely a good lesson to learn. 

Fast forward several years, and after becoming more involved in the church and getting to know the pastors, they have now made accommodations to make the gluten free communion safe for those who need it. They were unaware that cross contamination was a concern. As far as I know, the individual who originally requested gluten free wafers has celiac disease, but they're not at all careful and often "cheat" on the diet. They didn't think it was a concern to mix the wafers, so the church never knew. Now, they have a separate container for the gluten free wafers based on my suggestions. I confirmed they are safe for me to consume even with my other food intolerances/allergies. The individual that puts them in the container makes sure their hands are clean prior to doing so, and instead of a pastor handing the gluten free wafer to communicants, they allow us to pick up the gluten free wafer ourselves so they don't contaminate it after handling the regular wafer. They will eventually figure out a solution for the wine but for now, I just skip it. 

Ener-G Communion Wafers that my church uses.

I've also been to another church where they have the gluten free wafers wrapped in saran wrap on a separate part of the plate where they keep the regular wafers. They allow the individual to pull a gluten free wafer from the plastic. They also do the small individual cups of wine, so I am able to consume the wine there as it is not contaminated. A friends church has 100% gluten free communion so there is no chance of cross contamination (I would love to attend a church like this). 

So now to my point and the education part: 

Different churches and denominations handle communion in different ways. In most Protestant churches (including Lutheran), they are able to use a gluten-free wafer such as the Energ-G Communion Wafer pictured above that my church uses. I've also heard of churches using homemade bread or even crackers as a substitution to ensure they have a gluten free product. 

The problem is the potential for cross contamination at various points including the handling of the wafers, storage of the wafers, distributing of the wafers, contamination of the wine, etc. Those are all things to take into account if you are going to ensure what you are consuming has not been contaminated by gluten. Most churches are open to discussing various aspects to see what they can do to work with you. I've even heard of individuals bringing their own bread and carrying it with them to the front of the church for the pastor to bless it rather than anyone else ever handling it. This should be discussed with the pastor ahead of time as some churches wouldn't allow that as I understand it. 

I don't know from personal experience, but I've heard things are much harder in Catholic Churches. Unfortunately, the wafers pictured above do not meet the requirements for the Catholic Eucharist. According to Catholic Celiac Society:  

Because the Catholic Church states that Communion bread must be made of only wheat and water with "sufficient gluten to attain the confection of bread," the only option for the Catholic celiac has been to receive Communion under the species of wine alone.

The link goes on to say...

The Benedictine Sisters of Perpetual Adoration in Clyde, Missouri, have developed a Communion host that is extremely low in gluten....

According to the Sisters, they were tested to a level of 0.01% gluten. 

There have been several arguments regarding the safety of these "low gluten hosts," and it is up to the individual to decide if they think it is a risk and whether or not it is a risk they are willing to take. 

I encourage you to click on the link above for the Catholic Celiac Society if you are Catholic for additional information as there is a lot of information I simply don't know as I am not Catholic. Protestants have different beliefs than do Catholics, but it is an important part for most Christian denominations and I am thankful every day that I have a safe option. Personally, I didn't realize how much I missed it until I was able to receive communion again. 

Gluten Free Museum

A friend shared a link with me from Buzzfeed and asked me what I thought of it. It referenced a Tumblr post titled Gluten Free Museum which was meant to show how prevalent wheat is in our culture. I didn't really read anything the first time I looked at the link on Buzzfeed, so all I saw were pictures like these:

 Photos courtesy http://glutenimage.tumblr.com/

My first reaction was that it wasn't necessary to remove the majority of the items. I liked the wheat field best because they at least replaced the wheat with grass, but those tools could have been used for the grass too, so removing those made no sense. When it came to pictures like the woman pouring water with the basket of bread, I figured they could have used gluten-free bread. The portrait of Andy Warhol with a cheeseburger could have been on a gluten free bun--or they could have at least left the ketchup in the photo as that should be gluten free although a portrait of a person with a bottle of ketchup would be quite odd. 

I voiced my concern about the fact that items don't cease to exist if everything needs to be gluten free. There are gluten-free breads, cakes, beers, etc, etc, etc. Why did they need to remove these items instead of replace them???

She responded with the following: 

I think it's to make people who don't have to think about gluten every day, every meal look at how important gluten is, how prevalent it is in our culture.

I felt a little foolish. Mrs. Positivity (me, if you weren't sure who I was referring to) had immediately jumped on the defensive. I'll admit I may have taken a different stance if I had actually read what the page said (that was the whole point of it) instead of simply looking at the pretty pictures. I think it's a good reminder to myself (and others) to look at all sides before making any snap decisions.

With that being said, I highly recommend checking out the links below to see all of the photos. 

Tumblr Link

Buzzfeed Link

Dangerous Minds Link

I Missed the Anniversary of My Diagnosis

Apparently after seven years, the anniversary of my diagnosis is less of a big deal, because I was mistaken on the actual date. For some reason, it seemed to have more meaning to me this year. I decided I was going to really take note of March 28th. Unfortunately, when I double checked a calendar, I realized it was March 27th, 2008 when I was diagnosed. I also realized I missed my "blogiversary" (the day I started this blog). That date was March 17th, 2013.

What does all this mean? I'm not really sure, and quite possibly, it means absolutely nothing. Webster's dictionary defines anniversary as:

Yes, the anniversary of my diagnosis was most definitely a special or notable event. I had struggled for over ten years with horrible gastrointestinal issues. I had a million other symptoms that I never realized had anything to do with each other. These included mouth sores, dry flaky & painful skin, achy joints, brain fog, debilitating fatigue, etc, etc, etc. I'm thankful that the doctor I saw that day immediately knew what was wrong, and he happened to be right. My assumption walking into the appointment was that I would have yet another doctor tell me I had IBS and I needed to eat more bread and crackers when my stomach was upset. It was a huge relief that one simple condition could explain everything wrong with me including the major depression I had suffered with for years (I didn't find this out until later).

I was told to remove gluten from my diet, and when I asked how to do that, I was told to go home and look it up on the internet. I must mention that I am amazed at the fact that doctors still give this same advice to patients despite all of the misinformation on the internet and the fact that there is amazingly accurate information from all kinds of reputable celiac disease organizations. I was shocked at the advice, but I went home and did just that. I quickly found a very helpful online forum. I wish that forum were still around so I could go back and see my original post. I'm curious what I said...if I sounded desperate or scared or if I took the stance of overconfidence.

I made a plan to completely remove gluten from my diet that coming Sunday. I have no idea what I ate the rest of that Thursday, or the subsequent Friday or Saturday--I simply remember that I was going grocery shopping the first chance I got which was Sunday. I looked up all of the common ingredients where gluten could hide, and was convinced I was familiar enough to go for it.

I went grocery shopping alone that Sunday. I started in the back aisle as I always do, and I literally went up and down every single aisle until I got about halfway through. In this time, I scanned each item on the shelves, and if I thought it might be gluten free, I picked it up and began reading ingredients. Even those items that didn't seem to have any reason to contain gluten did, such as...

Rice-a-Roni

Twizzlers

Candy

Eventually, it felt like all I was seeing was this on every. single. item.

The picture above does a good job of explaining my experience. I wish I had taken a picture of the contents of my cart (that was long before I had a smartphone, and I doubt if I had a camera in my purse), because although I don't remember what was in there, I know it was very little. By time I got about halfway through the store, I was exhausted and defeated. The one shining note was when I found the "gluten-free section." At the time, this section was about five feet wide (now, it's about 15 feet wide). I skipped the majority of the remaining aisles, and decided I was done.

I had no idea what I was going to eat that week. I was scared that I would never figure it out. As I approached the checkout lanes, my phone rang. It was my boyfriend asking me to grab him milk. I tried to explain in as few words as possible that I simply didn't have it in me to go to the back of the store because I feared if I said too much, I would burst into tears. He was mad, but I went home without milk.

The second I got into my car, I burst into tears. I knew it wasn't the end of the world, but I felt absolutely, completely defeated.

I wound up eating chicken and potatoes for most meals for several months. Eggs made a simple breakfast. I also bought Ensure to supplement my meals to ensure I was getting adequate nutrition. Bananas were also a common snack. I quickly figured out that the Enjoy Life Foods Soft Baked Cookies didn't taste amazing, but they were good, and they were filling enough to eat as a snack.

Seven years later, it's rare that I have anything close to a defeated feeling (although it does happen). It's second nature to find gluten-free products. I've taught myself to cook, and I really enjoy it. I'm glad I did it the way that I did--went 100% immediately--even though it was really hard. Most individuals I've talked to removed the obvious things, and continued doing so until they had removed gluten completely. I see why people do that, but I've seen far too many people continue eating gluten for much longer than necessary because there are one or two items they didn't think to check. When it comes to celiac disease, it's 100% or nothing, so why go through the hassle if you don't have it all removed from your diet anyway?

If I could give any advice to anyone starting out, I would encourage them to figure out things they can eat that should be available prior to leaving for the grocery store. It's also best to stick to the outside of the store where all of the fresh fruits, veggies, meat, and dairy are. Ingredient lists are short or non-existent, which makes things easier.

Enjoy Life Foods Joins Mondelez International

A couple days ago, I saw news that normally would have made my heart sink...Enjoy Life Foods is joining Mondelez International. I saw a post on their Facebook page that they had exciting news to share.

I quickly clicked the link to read the announcement. I'll admit that I was initially very skeptical. Enjoy Life Foods, the company that I have come to rely on for a product that is 100% safe all of the time for me was joining forces with a company that I literally NEVER buy products from. After about the 50th phone call to Mondelez International to find out if one of their products were gluten free and being told they don't know, I gave up. No longer would I call, I would simply avoid all of their products. This is no small feat considering how incredibly large this company is which makes it incredibly hard to avoid their products. Now I was faced with a huge dilemma.

After some reflection on the topic, I commented the following on their post:

Part of the reason I went with a positive response was the amount of anger and backlash they were receiving. Part of the reason I went with a positive response was that I prefer to look at the positive side of things whenever I possibly can. Part of it was also that I've met representatives from their company multiple times. They are a company that truly does care about their customers. Mostly, it's because they are the one of the companies that has enabled me to feel truly alive without gluten.

The only complaints I've ever heard towards Enjoy Life Foods is that their products don't taste that great or that they are overpriced.  I'm not sure I've ever heard those complaints from someone who requires products that are gluten and allergen-free because they realize there really are no other options. I also understand it costs a lot more to find ingredients that aren't mainstream, and their strict manufacturing practices add to their costs also.

The reason I decided to cover this topic in my blog was actually spurred on by emails between myself and another blogger that contacted me. She was hopeful, but very concerned regarding this news. In our conversation, I said the following:

I guess what is giving me hope is that Enjoy Life is basically nothing without continuing with what their company was founded on. They make amazing products that are gluten, allergen, and gmo free, but if you were to put those same products up against other similar products that contain allergens, gluten and/or gmo's, I can't believe that they wouldn't go out of business in a heartbeat.

In my opinion, that is the bottom line. To someone who has allergies/intolerances, they need Enjoy Life Foods. If they no longer meet their allergen requirements, then they've lost those customers. In all honesty, they probably don't have many customers beyond those with the needs they are meeting. If you were to put 10 different chocolate snack bars into a blind taste test and include the Cocoa Loco bars, the Cocoa Loco bars would probably come in last or close to last. It's not because they taste bad, it's simply because when you have the option of including any ingredient, you can make a better tasting product.

I've had many friends without allergies/intolerances try their products. Some like them, some don't. I'm pretty sure only one person has ever claimed their products were inedible. That person was crazy in my opinion. If I were magically cured of all of my allergies/intolerances, I wouldn't continue purchasing their products as often, but because I believe in the company, I would purchase them occasionally. I feel products with a worthy cause are worthy of support. I know that without customers, companies go out of business.

Will I continue to be a customer of Enjoy Life Foods if they don't stick with their promises they made in their announcement? It's very unlikely. Will I be disappointed if they aren't able to lower their prices, increase distribution, and expand their product line? Yes--but only because I don't see any point in their merging with a company such as Mondelez International in that case. In the end, I'd like to say that I'm optimistic with a hint of caution regarding this announcement. I won't say cautiously optimistic only because my optimism is definitely outweighing my caution ;)

If you'd like to see another viewpoint similar to my own, I highly recommend this blog post by Celiac and the Beast. I like seeing other people being supportive and being aware of the bigger picture in this situation.

I'll continue to follow this story, and I'm definitely interested in seeing how things turn out.

Could Cheerios Make Things Harder?

Yesterday I heard big news that has been spreading like wildfire ever since it was announced. Cheerios is changing their formula so that it is gluten-free. My immediate assumption was that they were going to use certified gluten-free oats like every other gluten-free product that contains oats. I'm waiting on confirmation, but at this point, I'm assuming it's unfortunate that they aren't using certified gluten-free oats for various reasons.

The great thing about Cheerios was that they didn't need to change their actual ingredients for their original Cheerios to be gluten-free. I often wondered why they didn't make a gluten-free version using certified gluten-free oats, charge a slight up-charge because those oats would be more expensive, and then it'd be similar to what Kelloggs did with Rice-Krispies. They have a regular version, and they have a gluten-free version.

General Mills chose to take a different approach and simply change all of them to gluten-free. According to the General Mills blog:

We’ve developed a way – years in the making – to sort out the small amount of wheat, rye and barley in our supply of whole oats that are inadvertently introduced at the farms where the oats were grown, or during transportation of the whole oats to the mill.

Due to everything I've ever read in the past, their procedure kind of scares me. I would assume a company as large as General Mills would be absolutely sure, but when I read an article on Gluten Free Watchdog, I knew I was right to worry. According to Tricia Thompson (founder of Gluten Free Watchdog),

It is important to remember that there are two major activities required to bring gluten-free oats from field to table. The first is production, which takes place at the farm and involves seed sourcing and planting, growing, harvesting, transport and storage. The second is processing, which takes place at the mill and involves cleaning, mechanical sorting, dehulling, stabilizing against rancidity, and transforming into flakes, flour, steel-cut, whole groats, and bran for human consumption. Contamination can occur anywhere along this route.  

She ends the article on her site with the following plea to manufacturers:

We ask manufacturers to please use only specially produced gluten-free oats (as defined by Health Canada) in their labeled gluten-free products. It is the opinion of Gluten Free Watchdog that a truly gluten-free source of oats begins with the use of pure seed and follows an established purity protocol. At Gluten Free Watchdog we understand that there is promising technology with optical sorters and other proprietary mechanical sorting processes that allow oats to be processed to remove barley and wheat grain. More information is needed before we can assess whether these sorters will allow “regular” oats to be processed enough to effectively and consistently remove wheat and barley. As always, Gluten Free Watchdog will continue to monitor the issues concerning the use and labeling of gluten-free oats. 

There are a lot of people complaining that an estimated 20% of those with celiac disease still can't consume oats. Other complain there are ingredients in Cheerios that aren't health. The list of complaints goes on and on, but I prefer to focus on the main issue at hand. Will they or will they not be gluten-free. Even Tricia Thompson isn't able to say yes or no for certain, but I love her plea to manufacturers. It seems so much simpler to just use a safe product rather than hoping you can "decontaminate" an unsafe product.

I definitely have other questions regarding this topic. First, are there even enough certified gluten-free oats for General Mills and all of the other manufacturers that already use them. Is it possible that General Mills use of them could cause a shortage which could put other companies out of business? If there aren't enough, could General Mills have their own fields to grow certified gluten free oats for their products?

And then I look at worst case scenario... say they usually test under 20ppm to meet FDA guidelines, but they sometimes test slightly over or just under and many individuals get sick? I assume the FDA would shut them down, or they would pull the gluten-free claim voluntarily. I guess my biggest worry is having one more thing I have to explain away to people. If it's labeled gluten-free, then it should be safe for those with celiac disease to consume, and it's very frustrating to explain to people why I have to second guess claims.

This could all be worry over nothing, but I personally think it's worth it to do additional investigation to be sure. If we all blindly follow the claims of manufacturers (big and small), then aren't we opening ourselves up to harming ourselves by ingesting gluten? I'm very interested to see how things work out. Kudos to General Mills if their process is truly safe, but shame on them if they haven't done enough research.

Do Doctors Know What They're Doing?

I'd like to start this out by saying that I realize that there are multiple reasons doctors don't/can't know everything about every possible illness. I also realize that there are many amazing doctors that do the necessary research to ensure they are diagnosing individuals correctly AND prescribing the correct treatment.

But then there are articles like the one I just read. The article titled "Many Providers Stray From Guidelines For Diagnosis and Management of Celiac Disease" cites a study (although small in my opinion) that confirmed doctors aren't following proper guidelines when it comes to the diagnosis or treatment or celiac disease. I'd absolutely love to have more of the story. I want to know why they aren't following guidelines. I want to know what is causing this whether or be stubbornness or lack of access to information. I want to know more! :)

The biggest problem I see in providers not diagnosing correctly or prescribing the correct treatment is that individuals then don't know what they're doing either. I can't describe the frustration I feel when I see people asking for help when it comes to celiac disease, and people coming up with the craziest of answers. I'm all for individuals making their own choices, but many are doing this without doing their research or truly understanding the repercussions of their actions.

There is this crazy process with celiac disease where individuals either can't find a doctor who recognizes the symptoms or refuses to test them. If they do find a doctor to test them, incorrect testing methods are often used leading to an inaccurate or incomplete diagnosis. If they do receive a diagnosis, the method of treatment is often incorrect.

My experience went like this:
1. For over 10 years, I dealt with "classic" symptoms of celiac disease. I was often told I had IBS, and I was prescribed various medications that happened to have a side effect of constipation to help offset the diarrhea. I was also told to "eat more bread" because that would help my constant stomach upset.
2. I finally found a doctor who looked me straight in the eyes after I went over my laundry list of symptoms and told me he didn't even need to test me--he knew I had celiac disease. He said I needed to start a gluten-free diet immediately, and I could look it up on the internet to figure out how to do it.
3. He ordered blood tests and a colonoscopy to confirm the diagnosis he was sure of anyway. Unfortunately, the tests he ran did not constitute the full "celiac panel" which meant I never got that definitive answer. When I finally got in for the colonoscopy about eight weeks later, the gastroenterologist said I should have an endoscopy to confirm celiac disease. By that point, I had done enough research to know that I should have had an endoscopy in the first place, and it was probably pointless at that point because I had been on the gluten free for eight weeks. I agreed for them to do it because I had already done the prep, and the doctor explained it was possible they would still find damage.
4. When I went to the follow up appointment for the colonoscopy and endoscopy, the gastroenterologist greeted me by saying something to the effect of, "Congratulations! Your biopsy was clear, you don't have celiac disease." I don't recall exactly how many biopsies they took, but off the top of my head, I believe it was only one or two (the last standard I read was a minimum of 7 as damage is usually very patchy).
5. My blood tests were never explained, and I had to request the records a year later when I had a better understanding of the disease as a result of my own research. I was curious if the diagnosis was correct, and I was angry and frustrated and hoping it was actually something else. Despite the fact that the wrong tests were run, deep down I knew I had it, and I couldn't bring myself to purposely ingest gluten to have the tests run again.
6. A few years after my diagnosis, while questioning other intolerances and such, I remember my doctor saying that I needed to "avoid" gluten when possible. He looked at me like I was a crazy person when I explained how strict I needed to be due to how sensitive I was, and how horrendous my reaction was to small amounts of it. I questioned his method of diagnosis, and he looked puzzled at the possibility that he had done anything incorrectly. At the same time, he looked me straight in the face and confirmed that I definitely had celiac disease.
7. I changed doctors and I basically don't mention celiac disease. At this point, I've done countless hours of research, and unless I get lucky, I figure I know more than the doctors do, so I'll manage it myself.

It's crazy to me that basically everything was done wrong every step of the way. It wasn't even just one doctor that did things wrong. It seems every practitioner I have ever seen has no clue what the diagnostic or treatment process is for celiac disease. I will continue to believe I have celiac disease because I did have "classic" symptoms that resolved on a gluten-free diet, and I have a horrible reaction to it even when I have no idea that what I've consumed contained gluten, so it's not a placebo effect. I'm quite certain that I would have received the "gold standard diagnosis" had the doctors realized what that was and how to do it.

Am I angry that doctors don't understand? I'll admit that I do get angry sometimes, but more than anything, it's frustration. There are multiple reasons that it can be incredibly hard to receive a diagnosis of anything, and it would be impossible for a doctor to know everything about every possible illness.

Due to all of these details, I will always be an advocate for informing individuals of the correct process to receive an accurate diagnosis.

If you are interested in more information on the correct diagnostic process, you can click here for a quick description of the process I did and/or click here to read a previous post of mine on why I think it is so important.

I hope to do a future post with links to the various research clinics and how they describe the process because the research study I originally referenced basically only says what the doctors are doing wrong. It would be very hard to realize why the study is so concerning unless you are familiar with the process.

The Fear of Pooping in a Dressing Room

I'm not entirely sure how to explain, but I've always had a fear of urgently needing to poop while trying on clothes in a dressing room. Imagine my surprise when I read an article titled Why taking a dump in a Kohl’s dressing room is never a good idea.  The craziest part is that I buy the majority of my clothes at Kohl's...where the juniors dressing rooms are usually located "conveniently" at the opposite end of the store as the restrooms.

I absolutely HAD to read it. In the article, he calls the man who poops in the dressing room Dirty Randy. Is it sad that I REALLY want to talk to Dirty Randy? I want to find out so many things...

• Did he know he had to poop when he entered the dressing room?
• Did he purposely go to the dressing room to poop?
• Had he done this before?
• Was he to embarrassed to tell his wife he needed to poop, so he chose the dressing room over the restrooms?
• Would he answer questions indefinitely until I was satisfied with his reasoning?

If you haven't read it yet, I highly recommend you do if you ever had the urgent emergencies often associated with celiac disease pre-diagnosis. 

It's rare at this point that I experience stomach issues while shopping, but I still have anxiety which makes me fear I will have stomach issues even though I'm simply imagining it. One of my worst nightmares was being in a dressing room and needing to go NOW. What would I do? Grab my clothes and run to the restrooms across the store wearing what I was trying on? Would they attempt to arrest me for shoplifting in the process? Would I try to poop in a corner like this man seemed to have done and hope no one noticed so I could hide in the clothes? How would that poor store clerk feel when they discovered what I had left behind? 

It's crazy to me that after so many years, I'm still so incredibly afraid of the potential of having an "accident." 

I do have to say that after my diagnosis, it's rare I think the restroom signs should look like this: 

ETA (12/29/14): I just discovered my husband never read this post. I was shocked to discover he had no idea I had this fear. He questioned why I would ever poop in a dressing room. My response was, "What if you're trying on clothes, and your stomach goes completely crazy, and you absolutely positively need to poop RIGHT NOW!!! There is no way you can get your clothes back on and/or rush to the restroom across the store in the clothes you're trying on. What other choice do you have?" He simply looked at me dumbfounded. Apparently he's never had stomach issues ;)