Ask the Doc: Tics and celiac?

Posted on February 11th, 2008 by Alison | Posted in Ask the Doc, Celiac Disease, Symptoms | Read 3 Comments - Add Your Own »

questionmarkgreen1.jpgQ. 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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Ask the Doc: Sleep issues and celiac

Posted on January 10th, 2008 by Alison | Posted in Ask the Doc | Read 3 Comments - Add Your Own »

questionmarkgreen1.jpgQ. 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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Ask the Doc: Wrong diagnosis?

Posted on November 16th, 2007 by Alison | Posted in Ask the Doc | ADD A COMMENT »

questionmarkgreen1.jpgQ. 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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Ask the Doc: Sources of fiber?

Posted on October 9th, 2007 by Alison | Posted in Ask the Doc | ADD A COMMENT »

questionmarkgreen1.jpgQ. 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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Ask the Doc: Food allergy test vs. celiac test?

Posted on September 17th, 2007 by Alison | Posted in Ask the Doc, Celiac Disease, Food Allergies | Read 1 Comment - Add Your Own »

questionmarkgreen1.jpgQ. I just had food allergy testing (FOODstats Elisa test for IgG and IgE) and have been searching for information regarding IgG response to foods. So far all I can find is that an IgG response does not prove I have a food allergy. My reactions were high for the following foods: wheat, wheat gluten, gliadin, whole wheat flour, white flour, spelt, all dairy including milk yogurt, casein, eggs yolks, egg whites, bananas, pineapple and I even tested positive for sugar. I had a blood test for celiac about a year ago and it was negative. Do I take these results with a grain of salt or could there be some validity here? My husband has almost identical allergies although he had several IgE reactions.
Thanks for your insight!

A. Whenever you have multiple food allergies, this suggests that your gut is leaky: that is, the junctions between your intestinal lining cells have been disrupted. Protein fragments from wheat, barley and rye, that cannot be completely digested by your own enzymes can cause the disruption, and do not have to go through the classic celiac disease mechanism that depends on genetic factors, antibody generation (anti-tTG or anti-gliadin antibodies). Thus, you will test negative to standard blood tests (which in commercial labs may only be 45% sensitive) for celiac disease. You must get HLA DQ2 andDQ8 testing, and consider an intestinal biopsy. You may have NCGS — non-celiac gluten sensitivity. My advice: get HLA tested, get an intestinal biopsy, then go on a gluten-free diet.

Health and happiness,
Dr. Aron

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Ask the Doc: Will my second baby have celiac?

Posted on August 10th, 2007 by Alison | Posted in Ask the Doc, Celiac Disease | Read 3 Comments - Add Your Own »

questionmarkgreen1.jpgQ. Please help. I am 7 months pregnant, and my 3 year old child was diagnosed with celiac shortly after my husband and I found out about the pregnancy. I asked his GI doctor what to do about preventing the onset of celiac with our second child and she knew very little to tell me. I would like to know the percent chance that baby #2 will have celiac. Child #1 is the only person in the family with it as far back as we know. Should I breastfeed this baby? Do I need to be on a gluten free diet when breastfeeding? When should I introduce gluten in baby #2′s diet?

A. The best answer appears in the British Journal “Gut” 25 April 2007, from Bourgey, M et al. You must test yourself, you husband, your first baby for HLA-DQ2 and HLA-DQ8 genes. The lab must test for the alleles, or components of these genes. If you or your husband both have HLA-DQ2 with 2 copies of DQB1*0201, then there is a grerater than 80% chance that the new baby will have celiac disease. If the alleles of you and your husband are DQB1*0201 and DQA1*0501 and in a trans position, then there is a 68% chance for the baby. If these alleles are in a cis position, then a 23% chance is possible. If both of you have DQB1*04, then there is a 1% chance. If there is one copy of DQ8 and one copy of either DQB1*02 or DQA1*05 then a 1 in 50 chance. So you will need to contact Prometheus labs in San Diego to get these tests.

Breast feeding is safe and even helpful. You should be on a gluten-free diet while breast feeding. Do not introduce gluten until solid food is taken, which is usually after 6 months. Good Luck.

Health and happiness,
Dr. Aron

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Ask the Doc: 5 week old baby with celiac?

Posted on July 17th, 2007 by Alison | Posted in Ask the Doc, Celiac Disease | ADD A COMMENT »

questionmarkgreen1.jpgQ. A baby 5 weeks old while only on breastmilk developed diarrhea and blood in the stool. A celiac center claimed they had just returned from a conference in Maryland that said it is impossible to have celiac at that age because the body can’t produce antigens at that age. However a different center said the opposite. When I asked the first if a baby could be gluten intolerant through the breastmilk and cause a similar celiac symptoms they said yes but not the classic immune disease disorder. Can you clarify the facts? Other common allergen foods such as nuts, shellfish, milk, eggs and soy have already been eliminated from the diet.

A. Your question is not easy to answer as we lack data on gliadin (gluten protein) levels in breast milk of mothers who have proven celiac disease. One study (Chirdo FG et al Scand J Gastroenterol 1998;33:1186), demonstrated high levels of gliadin and antibodies to it in breast milk of non-celiac mothers. Three days of a gluten-free diet did not lower the levels of gliadin in the milk of 6 mothers. One mother with proven celiac disease on a gluten free diet had no measurable levels of gliadin in her milk. Many other studies have demonstrated that breast feeding actually protects babies from celiac disease, so in this case, another, more common cause of bloody diarrhea in the baby in question needs to be found. I suggest that you take the baby to a pediatric gastroenterologist to disclose the cause and arrive at specific treatment. What we do know is that the baby has only a 10% chance of getting the disease if either parent has it, and that the introduction of gluten in the diet before four months will lead to an increase in tissue transglutaminase, but that usually does not translate into major disease until development becomes more obvious, and will present as behavioral abnormalities such as learning disorders, neurological problems such as seizures, and decreased weight for height. Again, bloody diarrhea at five weeks is not celiac disease.
Health and happiness,
Dr. Aron

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Ask the Doc: Are celiac blood tests accurate?

Posted on June 25th, 2007 by Alison | Posted in Ask the Doc, Celiac Disease | Read 1 Comment - Add Your Own »

questionmarkgreen1.jpgQ. How accurate are the blood tests for celiac disease?

A. The commonly used antibody tests (IgA anti-gliadin and anti-tissue trans glutaminase) can diagnose aobut 85-90% of those with celiac disease. A total IgA (immunoglobulin A) level must be done, because 10% of celiacs are deficient in this immunoglobulin, and these antibodies may be falsely low in this setting. On occasion, even those with biopsy-proven disease may test negative, so it is recommended that genetic testing for HLA-DQ2 and HLA-DQ8 genes be done. Either one or both are positive in 95-98% of celiacs, but are also present in about 25-30% of the population at large, so an intestinal biopsy remains the gold standard for diagnosis.
Health and happiness,
Dr. Aron

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Ask the Doc: How long for symptoms to show?

Posted on June 15th, 2007 by Alison | Posted in Ask the Doc, Celiac Disease | ADD A COMMENT »

questionmarkgreen1.jpgQ. I have been gluten-free since Sept., 2004, although a biopsy came back negative at that time. I have experienced a night and day difference on the diet, and as a result, my partner and I work very hard to keep my diet extremely clean. However, I have noted that there are some things that I consider GF based on the listed ingredients and what the manufacturer tells me, that I get gastrointestinal symptoms from. Can you tell me if there is a way to narrow down what the culprit might be by how long it takes for me to have symptoms? In other words, if I go to a restaurant, and I eat something that has cross contamination from say a grill or utensils that are used in the kitchen, I know that within the hour. But there are times when I don’t exhibit any symptoms for 4 or 5 hours. I am wondering if this is because the ingredient I am responding to is such a trace ingredient, that I don’t feel it till the food is broken down to a certain level, way beyond the superficial. Is that a possibility, or am I way off base here?

A. We know that small fragments or peptides of glutens are directly injurious to the gut. These are independent from the celiac mechanism. It probably depends on the dose and variety of peptides that arrive in your gut. You’ll drive yourself crazy trying to figure it out, but it is likely that you will not undergo serious damage from this occasional exposure.
Health and happiness,
Dr. Aron

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Ask the Doc: Celiac disease and cancer link?

Posted on June 1st, 2007 by Alison | Posted in Ask the Doc, Celiac Disease | Read 1 Comment - Add Your Own »

questionmarkgreen1.jpgQ. What is the link between celiac disease and cancer?

A. There is an increased risk of developing lymphoma of the digestive tract and the bloodstream in those who have celiac disease and go undiagnosed and do not eat a gluten-free diet, or in those who have celiac disease, and who do not stay on the diet. If the initial biopsy used to make the diagnosis was a Marsh III or worse (Marsh I means no architectural change to the villi; Marsh IV means complete destruction of the villi), then the risk is greater than the rest of the population that does not have celiac disease. There is a very slightly increased risk in developing other solid tumors of the gut, such as colon cancer or esophageal cancer, if one does not adhere to the gluten-free diet. If, at the time of diagnosis, the biopsy is Marsh III or worse, you should also get imaging of the rest of the small intestine. The best way for this is still the barium swallow small bowel follow-through test.
Health and happiness,
Dr. Aron

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