Q. I am 30 years old. My question is that for the last 6 months I have been getting really sick during the night. I have hypothyroidism, and am really hypoglycemic. It wakes me up at all hours of the night and running to bathroom with diarrhea. I called my doctor about 2 months ago and did a stool culture, but nothing showed up. I am at loss!! I have no idea what is going on with me? Is it stress?? I am going to school, but I don’t feel that stressed out. I am not on any thyroid med because for the last year my thyroid has been normal, I just had it checked two months ago. I had a really nasty stomach flu about 6 months ago, ever since then my stools are not normal. I am fine one minute and then sick the next. No throwing up, just the other end. All I know is I want to feel better. Any suggestions??? I am also wondering if I could have some sort of wheat or milk allergy? I eat a lot of wheat being hypoglycemic. And I do notice sometimes after having something from milk in my food, sometimes I wake up sick. The weird thing is that it happens in the night most. I do not feel like it is heart burn. Thank you for listening!! I would appreciate any suggestions!!

A. Any nocturnal diarrhea needs to be aggressively investigated. Celiac disease is a real possibility as is inflammatory bowel disease. Diabetes can present like this, and post-infectious irritable bowel syndrome is an outside possibility. You must see a gastroenterologist soon.

Health and happiness,
Dr. Aron

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Q. When my husband was 17 he was diagnosed with Celiac Disease and then just 2 weeks ago his father was diagnosed as well. I know there is a good chance our 14 weeks old baby girl could possibly have it as well, however, I don’t know when we need to get her tested. At three weeks old she lost a whole pound while breast feeding and our doctor suggested putting her on formula. She has been putting on weight, but not much. She weighed 5 lbs 6 oz after losing weight at three months and as of last week she weighs 9 lbs 6 oz even though she eats 4 oz of formula every hour and a half. Not being able to gain weight is only one of many symptoms our little girl has. Even our doctor says she has a lot of flatulence for one so young, her bowel movements have never been regular, one day she has acidy diarrhea and then she will be completely constipated the next. She is also very fatigued taking 4 or 5 two or three hour naps during the day and then sleep a full nine hours every night since she was 3 weeks old. I just want to make sure that we get her tested early enough to see if she has celiac or not before she has to suffer like my husband and father in law did for so long. So when can I have her tested?

A. There is a strong possibility that your baby has celiac genes, but, with a lack of exposure to gluten, it is unlikely that this is a cause unless you have been ingesting gluten during breast feeding. Switching to formula is a good idea: be sure that it is gluten-free. Testing the baby for celiac should include HLA DQ2 DQ8 genes, and be done very soon.

Health and happiness,
Dr. Aron

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Q. I was diagnosed with celiac disease Marsh IV three years ago. I did better for a little while but now I seem to be regressing. The doctor I had never said anything about follow ups, just stay gluten free. Am I at risk for more severe problems because it is Marsh IV? Can you regress even though you stay gluten free? I’m only 41 but have been feeling like 75.

A. You may be having “refractory celiac disease”, a much more likely event given your Marsh IV pre-treatment biopsy. You need to have the following: IgG and IgA anti-tTG antibodies tested, imaging of the small intestine by either barium small bowel xray, or CT enteroclysis, and a repeat biopsy. After that, a plan of further treatment can be established. If you are in Northern California, we could initiate these studies at California Pacific Medical Center. You should see a gastroenterologist in your area if not near us.

Health and happiness,
Dr. Aron

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Q. I had a positive transglutaminase and I am having an endoscopy done to confirm that I have celiac sprue. I am just wondering what other autoimmune/inflammatory diseases would cause a positive transglutaminase result?

A. Undiagnosed and untreated celiac disease is often associated with other autoimmune diseases, and thus a positive tTG antibody test may indicate the presence of other autoimmune diseases. That said, no one will diagnose you with an autoimmune disease based solely on the positive tTG; you’ll need to be tested for ANA, RA, and a host of others. The good news is that many of the associated autoimmune diseases with celiac disease can be reversed with a gluten-free diet.

Health and happiness,
Dr. Aron

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Q. I am concerned that my 2 1/2 year old daughter may have celiac. I am 37 and my 1st cousin on my father’s side has celiac disease, and my aunt (not her mother) on my father’s side had lupus (she has been dead over 30 years).

My daughter is about 33 inches tall and weighs 28 pounds. She is a very picky eater to begin with. She has about 3 to 5 bowel movements a day; these are all over the map in terms of consistency and size. She doesn’t stool at night and the colors of these BMs range from green to brown (never red, black, grey, or white). Sometimes I can see what she had eaten in them (i.e., grape skins) but she also doesn’t always chew her food in the first place!

We are going to see a pediatric gastroenterologist in our area. She has already had some labs done. I read another posting and will ask for the Prometheus Celia-Plus panel to be done. Here are the results from some blood work from Quest -

IgA Serum - = 51
Gliadin AB (IgA) = <3
TTG Ab IgA = <3

These are all in the normal range according to Quest.

We also did stool testing through Enterolab in Dallas.

A) Gluten Sensitivity Stool and Gene Panel Complete
Fecal Antigliadin IgA 222 (Normal Range <10 Units)

Fecal Antitissue Transglutaminase IgA 163 Units (Normal Range <10 Units)

Quantitative Microscopic Fecal Fat Score <300 Units (Normal Range <300 Units)

Fecal anti-casein (cow’s milk) IgA antibody 155 Units (Normal Range <10 Units)

HLA-DQB1 Molecular analysis, Allele 1 0201

HLA-DQB1 Molecular analysis, Allele 2 0301

Serologic equivalent: HLA-DQ 2,3 (Subtype 2,7)

These tests indicate that there is a definite problem - I guess gluten sensitivity and casein sensitivity. I don’t understand how 2 tests can be so different and the results came in within a week of each other; she has been on gluten and dairy the whole time and will continue to be until we meet with this pediatric gastroenterologist.

What is your thought on stool testing? I have not seen much positive response to it within the medical community online.

What should we specifically ask for when we meet? I guess a biopsy is needed to make a definitive diagnosis but I really, really don’t want to be so invasive with her. Any advice is much appreciated.

A. You should know that your daughter’s blood IgA levels are low, and that would make the IgA based antibody tests falsely normal. Secondly, commercial lab blood testing can be notoriously inaccurate, with sensitivity as low as 40% in some instances. The stool tests need to be validated in large scale trials with biopsy as the end point before they can be generally accepted. In your daughter’s instance, the tests strongly suggest celiac disease, but are confounded by the casein data: she needs an intestinal biopsy. My pediatric colleagues at California Pacific Medical Center are skilled and expert in this problem, and I’m sure that they can satisfy the situation. Please let me know how things are going, and I can arrange a consult with them for you.

Follow-up Q. You mentioned that the “casein intolerance confounds the issue.” I’m confused on that - does that mean that she MAY have only a casein problem? Do we need to eliminate one before the other? (casein before gluten, or whatever).

Follow-up A. Milk protein (casein) allergy can mimic the symptoms of celiac disease, but does not cause the same pathologic changes in the intestine as celiac. Therefore, an intestinal biopsy will resolve the issue.

Health and happiness,
Dr. Aron

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Q. My daughter (2 1/2) turned jaundiced a couple of weeks ago. For the past year and a half, she has never had a solid stool and her loose stools are foul smelling. She has always had a distended looking abdomen and did not start eating solids until she was 18 months old or she would throw up. Her hair is still thin and short like that of a one year old and her hair is very dry and lacks luster. She is very tiny. Lately, she began gagging herself and would let out huge belches, sometimes with a little vomit. Then when she turned yellow, the doctor tested her liver enzymes which were elevated. An ultrasound showed nothing amiss. Hepatitis and Mono tests were negative.

Finally, a friend told me that a friend of hers has a 5 year old who turned jaundiced and it turned out to be Celiac Disease. I have made an appointment with the gastroenterology department at St. Louis Children’s Hospital this Saturday to see if they can confirm. I have had many digestive problems and had wheat sensitivity show up in my own blood work since she was born. Now, I avoid wheat in general myself, but I have never had the endoscopy. I went ahead and took my daughter off of wheat and dairy five days ago and yesterday she had one of the first solid bowel movements I have ever seen from her. Her belly looks almost normal and she looks less jaundiced. So, I am wondering what you think as well. Thanks for your consideration!

A. Your case sounds very similar to one that I addressed several months earlier. Both you and your daughter need to be thoroughly tested for celiac disease, and that includes an intestinal biopsy. I’m glad that you made the right contact in St. Louis. I wish you and your family a lifetime of gluten-free health. Stick around, some exciting research is coming down the pipeline to make the millions of celiac sufferers achieve a normal life.

Health and happiness,
Dr. Aron

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Related reading: Symptoms of celiac disease

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Q. I’ve seen “neurological symptoms” listed as a possible symptom of celiac and gluten intolerance –are tics one of these possible “neurological symptoms”? My four year old is currently undergoing testing for celiac, but she also has begun to exhibit frequent and significant tics.

A. It is possible that the tics are related to celiac disease. Neurologic involvement in celiac disease is the slowest to resolve, as nerve tissue regenerates very slowly, so be patient with the gluten-free diet. You should also consult with a pediatric neurologist, as there may be symptomatic relief available while you await resolution of the problem.

Health and happiness,
Dr. Aron

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Q. I’m writing about an 11-year old boy who has shown some of the symptoms of Celiac disease. He also is having sleeping issues. To be specific, he’s still wetting the bed and he rarely sleeps though the night. He can’t fall asleep and he wakes throughout the night. Do you believe there could be a correlation?

A. You must actively pursue the diagnosis of celiac disease with a pediatric gastroenterologist, as there may be a relation. If so, treatment with a gluten-free diet could help.
Health and happiness,
Dr. Aron

(For a personal account regarding sleeping issues and gluten, read about Simon in Lan-Ping’s story)

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Q. Hi. I wonder if you could help me. I had a endoscopy done about four years ago and because I had flattened villi, I was diagnosed with gluten intolerance. As a result I went on a gluten free diet for a few months but still didn’t feel well, although my digestion improved. I had a barium x ray and found everything quite slow to move through my body. I also had another endoscopy which showed the villi back to normal again. I am concerned as I have read that flattened villi can cause colon cancer, which my Mum died of. I have not been on a gluten free diet because the consultant didn’t think I needed to be. However at 43, my digestion is poor and my stomach is quite bloated. I am very confused by the flattened villi matter and wonder if anything else can be the cause of the villi being damaged, such as a bout of food poisoning I had a few years ago. Please could you give me some advice.

A. Your question is very timely, as a recent article in the British journal Gut showed that patients who initially had an abnormal biopsy but continued to ingest gluten had the biopsy return to normal. However, the clinical manifestations of the disease continued, bringing into question our so-called “gold standard” for diagnosing celiac disease: an abnormal biopsy that returns to normal after gluten restriction. The point is that one does not necessarily need to have abnormal villi to have symptoms of celiac disease. There are other points to consider: did your doctor obtain at least 8 biopsies of your duodenum on the repeat study? The disease is very patchy and can be missed with one biopsy. Even on a single villus, there may be an uneven distribution of inflammatory cells. Was the initial biopsy well-oriented? Tangentially-cut sections of the biopsy can look like villus flattening, when there really wasn’t any. If everything was done correctly, then you must have imaging studies of the rest of your small intestine, and a colonoscopy, because, given your family history, and current symptoms, you may be at increased risk for bowel cancer. Best wishes to you.
Health and happiness,
Dr. Aron

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Q. I was told I should eat more fiber. So my husband told me to start drinking Metamucil. Is that a good source of fiber? Is Metamucil gluten free?

A. Metamucil is soluble fiber. Other forms of soluble fiber are oats (if you buy your oats from a manufacturer that only produces oats you’re safe from injurious gluten peptides), and stemmed vegetables. Brown rice and other non-gluten-containing grains such as amaranth and quinoa have insoluble fiber. You need a mixture of both kinds of fibers for optimal bowel health. Berries are another source, especially blackberries, raspberries and boysenberries. Basically, there are a lot of non-gluten sources of healthy fiber, so enjoy!
Health and happiness,
Dr. Aron

Answer to “Is Metamucil gluten free?”: According to the Metamucil website, all Metamucil Powders and Capsules are gluten-free. Metamucil Wafers, however, contain gluten (Apple 0.7g/dose; Cinnamon 0.5g/dose) because they have wheat flour as an ingredient.

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