Ask the Doc: Celiac, endometriosis and PCOS

Posted on February 17th, 2009 by Alison | Posted in Ask the Doc, Symptoms | Read 9 Comments - Add Your Own »

questionmarkgreen1.jpg Q. I have had polycystic ovarian syndrome (PCOS) for several years and luckily, though various fertility treatments, was able to conceive and give birth to two beautiful boys (ages 5 and 2).  Since my youngest was born via C-section, I had been having abdominal pain, cramping, intermittent diarrhea, etc.  I had never had gastro problems before this.  Last month, I had a laparoscopy that found endometriosis/adenomiosis/ovarian cysts, all of which were cauterized. I continued to be extremely fatigued, losing weight, diarrhea, etc., so on a whim I had a blood test for celiac that was suggested months earlier by my gastro.  Of course, it was positive.  I am just coming to grips with all this right now.  I am unable to work because I am in the bathroom half the day, on my heating pad for the continued back pain from the laparoscopy, and always exhausted.  My family is going on the gluten-free diet to see if that helps me feel better and I am going to have my allergist check me for other food allergies and for a Candida albicans yeast allergy (the allergist found earlier last year that I had virtually no immunity to any strep infection strains and after a pneumonia vaccine shot, the numbers improved – I had been having 8-10 sinus infections a year, flu/bronchitis twice in the past 3 years, and various other weird infections requiring multiple rounds of antibiotics).

My question is – are all of these (PCOS, endometriosis, celiac) related? Are there good resources on these diseases if they are or people who actually have all 3? I feel like every few months I find out something new about myself, so I feel like I flit from problem to problem instead of addressing a larger cause.

A. Endometriosis is a completely independent condition, but PCOS and celiac are related.  Treatment of the endometriosis should be explored with your gynecologist.  The gluten-free diet should help with the other problems, but remember that celiac disease is an inherited condition, so you’ve had this all your life, only to be unmasked by the C-sections.  Thus, it will be several months before you’ll see a major benefit of the diet.

Q. Can endometriosis be made worse by celiac disease?

A. There is no doubt that untreated celiac disease can lead to an excessive sensitization of the enteric nerves, and thus augment any pain that might arise from endometriosis. Endometrial implants on the outer surface of the gut are surrounded by connective tissue-as a way of encasing these abnormal tissues. That process can also involve the intestinal muscles and nerves, and, when activated by the immune cells in the celiac patient, the painful sensation is enhanced. I see this also in IBS and IBD and coexisting endometriosis. When I control the inflammation with gut anti-inflammatory drugs, the pain improves. Other than that, these are two independent phenomena that often interact, and one should not consider celiac disease as a cause or effect of endometriosis.

Health and happiness,
Dr. Aron

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Ask the Doc: Can celiac cause other food allergies?

Posted on January 6th, 2009 by Alison | Posted in Ask the Doc, Celiac Disease | Read 1 Comment - Add Your Own »

questionmarkgreen1.jpg Q. I had my gall bladder removed just over a year ago and then went through a series of tests because I wasn’t feeling better after the surgery. After much pushing on my part, I had the blood test done for Celiac and tested positive on one of the antibodies. My doctor sent me to an allergist who has done RAST tests on me and found allergies to numerous other foods. I am now on a very restricted diet. I know the Celiac is here to stay but is there any possibility that as my gut heals some of the other food allergies will resolve themselves? Should I be re-tested for these other allergies at some point or are they here to stay too? I’m frustrated and struggling to find safe foods. I feel so much better but I’m tired of rice and broccoli!

A. It is not uncommon for latent celiac disease to be activated by abdominal surgery. Celiac disease is often the primary cause for many other food allergies, but these secondary or “downstream” allergies all improve on a gluten free diet. I would recommend staying on the restricted diet for two months to allow the GFD to heal the gut, and then eliminate all the other restrictions but stay on the GFD for life.

Health and happiness,
Dr. Aron

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Ask the Doc: Can IgA level affect celiac testing?

Posted on December 11th, 2008 by Alison | Posted in Ask the Doc | Read 4 Comments - Add Your Own »

questionmarkgreen1.jpg Q. Is it common for kids (my son is 2.5) to have false negatives? How much does his IgA level affect the testing? My son has never had growth issues, is it still possible for his symptoms to be caused by Celiac? Can Celiac be jump started by rota-virus? Can the testing be misread?

Sorry for all the questions, but my son (2.5) has had chronic diarrhea, as well as many other issues, since he was hospitalized with rotavirus. After 2 endoscopes the cause of his problems is still undiagnosed. He is IgA deficient, but nobody has mentioned much about that, but I have read that can affect the testing.

A. Since the tTG antibody test is an IGA antibody, IgA deficiency will make the tests falsely negative. An IgG tTG test would be helpful, as would HLA DQ2, DQ8 genetic studies. If any of those are positive, he needs an intestinal biopsy. He may well have post-infectious irritable bowel syndrome, especially if there was stress at the time of the initial rotavirus infection. Very low doses of aminosalicylates such as balsalazide (use about 250mg in applesauce) daily could help.

Health and happiness,
Dr. Aron

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Ask the Doc: Shingles vaccine okay for celiacs?

Posted on November 3rd, 2008 by Alison | Posted in Ask the Doc | Comments Off

questionmarkgreen1.jpg Q. As a recently diagnosed 62 year old female with Celiac Disease I was wondering if it is safe to take the Shingles Vaccine. I have been told that it was not safe for those with autoimmune diseases. I have thyroid disease as well. Thank you for your help.

A. Actually, shingles vaccine should not be given to those who have an immune deficiency such as HIV disease, or those who are taking immunosuppressive drugs like azathioprine, 6-mercaptopurine, mycophenilate, or anti-TNf’s (Remicade, Humira,Cimzia).  Celiac disease is actually an over activity of the adaptive immune system, and should not prevent one from getting the vaccine.

Health and happiness,
Dr. Aron

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Ask the Doc: Cause of diarrhea at night?

Posted on May 13th, 2008 by Alison | Posted in Ask the Doc, Celiac Disease, Symptoms | Read 1 Comment - Add Your Own »

questionmarkgreen1.jpgQ. 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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Ask the Doc: When should I test my baby for celiac disease?

Posted on April 22nd, 2008 by Alison | Posted in Ask the Doc, Babies & Kids, Celiac Disease | Read 3 Comments - Add Your Own »

questionmarkgreen1.jpgQ. 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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Ask the Doc: Why am I not feeling better?

Posted on March 26th, 2008 by Alison | Posted in Ask the Doc | Read 2 Comments - Add Your Own »

questionmarkgreen1.jpgQ. 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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Ask the Doc: What can positive tTG test mean?

Posted on March 19th, 2008 by Alison | Posted in Ask the Doc | Read 1 Comment - Add Your Own »

questionmarkgreen1.jpgQ. 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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Ask the Doc: Blood test and stool test say different things?

Posted on March 10th, 2008 by Alison | Posted in Ask the Doc, Celiac Disease, Gluten Intolerance | Read 6 Comments - Add Your Own »

questionmarkgreen1.jpgQ. 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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Ask the Doc: Could my child’s symptoms be celiac disease?

Posted on February 18th, 2008 by Alison | Posted in Ask the Doc, Babies & Kids, Symptoms | Read 2 Comments - Add Your Own »

questionmarkgreen1.jpgQ. 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