Ask the Doc: Are follow-up tests needed after being gluten-free?

Posted on March 17th, 2010 by Alison | Posted in Ask the Doc | Read 1 Comment - Add Your Own »

questionmarkgreen1.jpg Q. What needs to be done or watched for once living gluten free, 4 years in my case, with nothing more than an occasionally accidental ingestion of some gluten?  Are there any tests that we should have, assuming everything else appears to be fine?

A. If you are well, then an occasional accidental gluten exposure is safe. Each individual has an unique reaction to gluten depending upon their genetics, the bacterial and viral environment of their gut,and many other factors.  To check for inadvertent gluten exposure, get an IgA anti tTG test.

Health and happiness,
Dr. Aron

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Ask the Doc: Can mouth symptoms be caused by gluten?

Posted on February 20th, 2010 by Alison | Posted in Ask the Doc, Celiac Disease, Gluten Intolerance, Symptoms | Read 1 Comment - Add Your Own »

questionmarkgreen1.jpg Q. Could symptoms labeled as Burning Mouth Syndrome be caused by gluten intolerance?  These symptoms have been constant for 5 2/3 years and include pain in roof of mouth, tongue, cheeks and under the tongue at all times except when eating. Additionally during the night I have pain above the roof of the mouth and into one ear and down the throat.

I have had nightly GERD for 8 years that doesn’t respond to any medications,  thyroiditis and nodules and increased vascularity in the thyroid, sometimes a fine tremor in my hands, and involuntary movement of my tongue and extremities. I also have had post nasal drip and phlegm for 25+ years which doesn’t respond to any medication nor was it improved by surgery to correct a deviated septum (which my doctor said left me with “perfect sinuses”.)

I know the thyroid symptoms may improve if gluten-free but are any of the other symptoms likely to be improved?

A. Sores or aphthous ulcers and taste disorders are common in celiac disease, as is reflux esophagitis, and thyroiditis.  You must get tested for celiac disease, and you must have a thorough investigation into your reflux, with endoscopy biopsy and manometry studies.You may contact my office at www.gut-check.com.

Health and happiness,
Dr. Aron

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Ask the Doc: Can I have celiac disease if I don’t have the celiac genes?

Posted on January 2nd, 2010 by Alison | Posted in Ask the Doc | Read 2 Comments - Add Your Own »

questionmarkgreen1.jpg Q. I just had a blood test to test for genetic predisposition to celiac because my mother is a celiac and I have a lot of the same symptoms. It came back negative and I am just wondering if it is possible to still have it. My doctor has completely ruled it out based on the test. Have you any idea what percentage of celiacs have no genetic markers?

A. The genetic tests for HLA DQ2 and HLA DQ8 account for 95% of celiacs. Celiac disease itself by the classical definition (positive anti tTG and EMA antibodies and a Marsh III biopsy) only accounts for half of all patients who are sensitive to gluten. There are a number of genes that are not currently tested for in clinical practice that have been associated with gluten sensitivity.  We currently are ignorant of their precise actions. You probably would benefit from a gluten-free diet.

Health and happiness,
Dr. Aron

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Ask the Doc: Is working in a bakery bad for celiac?

Posted on November 7th, 2009 by Alison | Posted in Ask the Doc | Read 1 Comment - Add Your Own »

questionmarkgreen1.jpg Q. I am a bakery manager. Last month I tested positive on the celiac blood tests. My father has been diagnosed with celiac, has both genes associated with the disease, as well as lactose and soy allergies now. I have had diarrhea for about a year and a half. My CBC didn’t show much to worry about but I was a little low on vitamin D, not dangerously so, just none stored up.

In my bakery I don’t actually work with the flour, but the bakery is an open environment. We also have  a cake decorating area and a coffee bar, where I generally work, about 30-90 feet away from the dough prep area. Is it possible that I will still be able to continue working in the facility as long as I wash my hands frequently, wear a mask when I am within 5 feet of dough prep area?

I am very concerned because I have been in the bakery industry my entire adult life, it is what I know. I started when I was 18 am now 39. The first 16 years were spent in a bakery that worked with frozen dough the one I currently manage is a full scale mostly scratch bakery. My plan was to see how an exclusive gluten free diet worked and if that did not change my symptoms and reduce my numbers then I would HAVE to consider a career change. However the more I read the more fearful I become that it is inevitable that I will have to change my job.

Do you have any advice or similar case examples you may be willing to share?

A. You need to get a biopsy, to assess the extent of your celiac disease: the more advanced the biopsy, the greater need to protect yourself. Gloves and a mask are a good idea.  There is some data on how much gluten will injure a celiac patient, but that data was generated in stable celiacs who have a normal biopsy, and may not apply to your case. I have had two patients who had minimal , and I mean MINIMAL gluten exposure and became symptomatic.  One was a waitress who was exposed to serving bread, buns, toast, pancakes, etc. She even could tell if someone switched the scoop from wheat to her grain bins at Whole Foods. Another patient would get sick just walking near a bakery!!!!

Health and happiness,
Dr. Aron

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