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  Ask Dr. Aron - Archive

Type II Diabetes, Diarrhea and Abdominal Bloating

I am 47 years old and have type 2 diabetes. I use to have diarrhea during the day or while I sleep. My doctor changed my medication to Glimepiride 4mg twice a day and Metoclopramide 10 mg also twice a day. I do not have diarrhea at all, but I have abdominal bloating all the time. What can I do or take??

Your doctor has given you the right medication. In the setting of type II diabetes, strict control of your blood sugar will eventually improve the bloating. Aim for a hemoglobin A1c level of less than 6. Once this happens, then the bloating should gradually go away. Your doctor may wish to add a TDZ drug to your regime, as this may help. Good luck, be patient.

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Severe abdominal pain on he right side under rib-cage.

I went to do an upper GI series last monday and the radiologist had mentioned that everything looks okay and I have nothing to be worried. However, I am still experiencing pain and for some reason it's getting worse. I went to the emergency room last month about 2 times in 2 weeks and both times I was there they refused to give me a CT Scan and they just did an ultra sound because they thought it was kidney stones or gallbladder stones. The pain is on the right side under my rib-cage and it is carried to the left lower back area, shoots to the right lower back and straight up to my shoulders. My doctor is convinced it could be an inflamed gallbladder and she ordered a CT Scan but they gave me a date a few months from now. I can't wait that long, I'm in severe pain. I'm nauseated, I barely eat and I'm losing weight and I'm gaining weight and I just don't get it. Do you have any idea? Not to mention I haven't had a bowel movement in days sometimes weeks. and when I do it's not normal, it's either diarrhea or it comes out flat. I have a problem with my face being dry and I have pimples. I have tried every pimple cream and lotion and I don't know what else to do.

You need to see a gastroenterologist very soon,and stop going back and forth to the ER. There are many potential causes for your pain, and a lot of them won't show up on a CT scan. If you are in the San Francisco Bay Area or northern California, you can contact my office.

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Continuous loose stool.

I was wondering if you could help me with some questions I have? I've been looking around for a while for pages that have my symptoms, but I can't find anything. I'm also a full time student on my own with no medical coverage, so I can't go see a doctor. My problem is with my digestive tract. Anything I eat seems to inflame something and I need to go to the bathroom asap. My symptoms are: hearing my digestive tract make noises, almost always wet and loose stool, wet leaking throughout the day so I have to wipe every hour or so. If I drink a protein shake, or take a multi vitamin I loose my energy and need to fall asleep, I'm always thirsty and my face is really dry on my nose and upper cheeks. Anything would help, even a point in the right direction to somewhere that I can get help.

You may have inflammatory bowel disease. Most gastroenterologists could see you and arrange an easy payment plan for you. You could go to the student health service at your school, where they can recommend a specialist. You need to see someone. In the meantime, take a couple of Pepto-Bismol tablets to help with your symptoms. They'll turn your stools black but don't worry, it's not blood but bismuth oxide. Good luck.

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HLA-DQ 6 and relation to nerve damage from gluten.

My son has tested positive for HLA DQ 2 for Celiac, and also HLA-DQ 6. Are you familiar with what the DQ 6 means? My understanding was that it is a gluten sensitivity gene, but not the classic Celiac gene. The reason I ask is because my mother-in-law started showing signs of dementia at age 55, and has deteriorated to the point where the doctors have ruled everything out except Alzheimer's. My question is, do some of these other gluten sensitivity genes have neurological effects, and is it worth it to try and convince my very stubborn father-in-law to have her tested? Incidentally, my son was diagnosed with Pervasive Developmental Disorder NOS, but has responded very well both physically AND mentally to removing gluten from the diet. That is what makes me think that perhaps my mother-in-law may improve on the diet as well. Thank you so much for answering.

HLA-DQ6 is on the same chromosome as HLA-DQ2 and DQ8: chromosome 6. HLA genes control the production of receptors on immune cells which recognize proteins to organize how the system will respond-either react or tolerate the protein. The exact role of DQ-6 is unclear as are the precise roles of other, non-HLA genes on other chromosomes that are involved with gluten sensitivity. The bottom line is that there is a strong probability that these genes may be involved in nerve damage from gluten, and that your mother must be tested. You and your family may be interested in participating in our research cohort for celiac disease, where we will explore the roles of genes, ethnicity, bacterial and viral factors as well as geographic microclimates in producing disease,and giving strong clues on new treatments.

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Testing 7 month old baby when mother and sibling have Celiac Disease.

I have celiac disease and my 2 1/2 year old daughter was diagnosed with celiac disease when she was 1 1/2 years old. Now I have a 7 month old baby and we have been feeding solid foods but avoiding all gluten containing ones. Is that necessary? Will eating gluten containing foods in first year for a baby born to a celiac mother increase chances for that baby for getting celiac. You do avoid wheat in baby if mother has wheat allergy? I know celiac is not a food allergy and is auto immune disease?? But is there reason to avoid or best to introduce?

There is no guarantee that your baby has celiac disease. You must get her tested to know for sure. If she is doing well now and thriving, then there is no urgency, but you should test her. The expression of the disease is quite variable, ranging from infancy with severe failure to thrive and many developmental problems to old age, with mild disease often not related directly to the gut. This depends on the inheritance, what dose of the genes and their expression, so, again, test the baby.

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Dysmotility of colon and in ability to swallow in a 7-year old

My 7 year old daughter has complete dysmotility of her colon and rectum. She is in pain daily. We have tried all kinds of medicines. In the last few years her symptoms have increased to her upper gi. Today she has choked several times while eating claiming the food is not going down. Have you heard of children with this? Is it progressive? What causes this? What are their lives like as they get older?

Your daughter may have one of a variety of hereditary visceral neuropathies or myopathies. She needs to see a Pediatric Gastroenterologist and a motility specialist right away. Fortunately, here at California Pacific Medical Center in San Francisco, we have a team that can help her. Contact me if you would like to come here for evaluation and treatment.

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Role of DQ2 gene in Celiac Disease.

I have just had a genetic marker test for celiac disease due to having severe digestive problems, weight loss etc. I had taken myself off gluten to see if it was the issue as the doctors could not find anything wrong. Other celiac tests showed negative. I showed up positive for the marker DQ2 but the doctor said he really could not tell me anything. From what I read that marker can be linked to Gluten Sensitivity that could lead into Celiac disease. I guess I would like to know if this positive result for DQ2 is enough that I should still stay away from Gluten.

While DQ2 is associated with 90-92% of proven celiac disease, it is also present in 37% of the general population, so while being very suggestive, it is not diagnostic. That said, go back on gluten for a month and then get an intestinal biopsy (your gastroenterologist should take 8-10 biopsies starting in the duodenal bulb and working down to the transverse duodenum) and have the pathologist stain for CD3 cells and count the number per 100 intestinal cells. More than 20/100 is abnormal. This will earn you the trophy diagnosis of celiac disease. On the other hand, there is emerging a condition known as NCGS, or "non-celiac gluten sensitivity", where patients are clearly sensitive to gluten, but test negative for all diagnostic tests. There are other genes involved, as well as primary injury to the gut from grain protein fragments known as peptides that are likely involved here. The bottom line is if you are better off gluten, then by all means avoid it. There is no side effect other than inconvenience or expense.

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Bleeding and hemorrhoids in colon.

I am 34 years old and about a year and five months ago I had a colonoscopy due to periodic bright red blood in my stools. My colonoscopy showed only internal hemorrhoids. I didn't have any polyps or anything else. Both of my grandfathers died of colon cancer. Even though the doctor told me that his banding of the hemorrhoids would only help a little, I am still afraid when I occasionally see bright red blood. Should I be okay since I had a colonoscopy done in July 2005 and it showed nothing but the hemorrhoids? How often should I repeat a colonoscopy?

If your grandfathers were 55 or less when they died, then every 5 years. If older, then every ten years. Try sitz baths in a warm tub up to your belly button for 15 minutes at least three times a week, don't strain, read on the toilet. Apply aloe vera gel to the anal area after bathing, eat fresh fruits and veggies, get regular exercise and relax.

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Irritable Bowel Syndrome

I am a middle aged man who has been diagnosed with IBS for two years. My stool often contains vegetables and I wanted to know the real reasons behind it. Normally, how long does it take to recover from IBS?

If you have IBS, then you have a condition that represents a continual intolerance of your digestive tract's immune system to the environment. This causes persistent inflammation which interferes with the functioning of your gut. Until you can find a way to reduce inflammation in your gut, you will have symptoms. It is not uncommon to occasionally see undigested food in your stool, but, when you see it all the time, you may have a more serious condition associated with poor absorption, and will need to see a gastroenterologist.

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Blood Test and Biopsies for Celiac Disease

My blood test came back positive for celiac sprue, but I have yet to get a biopsy on my small intestine. Is it very likely that I do in fact have the disease? Should I adhere to a gluten-free diet until I have a biopsy?

You should not be on a gluten-free diet until you get the biopsy. I don't understand the delay in getting the biopsy, but you want it to be as abnormal as possible, because too many inexperienced pathologists will not diagnose a minimally abnormal biopsy as celiac. You should have your gastroenterologist ask the pathologist to stain the biopsy for CD3 cells, and count the number of them per 100 intestinal cells. More than 20 25/100 are abnormal, and indicative of celiac disease.

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Celiac Disease and Thyroid Problems

I can't always keep gluten free, sometimes I get a hit from somewhere or something? My hair has begun to fall out at a rapid rate. Should I be taking any special vitamins?

You may have a thyroid problem, quite common in celiac disease, rather than a specific vitamin deficiency. You should return to your gastroenterologist and be checked for thyroid function, as well as for on-going gluten exposure by ttG and EMA antibody testing.

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Problems started after going Gluten free

I was diagnosed with celiac this summer. I was tested because my son had been diagnosed with celiac the month before. I myself had been entirely asymptomatic. Prior to my diagnosis I felt very healthy and energetic. Since going gluten free, I have not felt well. I have gas, my skin has broken out, I have periods of unexpected weepiness, and my hair is falling out. My family follows a lacto-ovo vegetarian diet and we continue to eat a lot of beans and whole grains (now quinoa, brown rice, and corn instead of whole wheat and barley). I take a multivitamin supplement. Any idea how my current functioning could be related to going gluten free or what I can do to correct it?

How were you diagnosed? If it was just on an anti-gliadin antibody test, it may be a false positive result, and you may have another auto-immune problem. Did you have an intestinal biopsy, and, if so, was it an advanced lesion? (chances are it wasn't since you were asymptomatic). You should go back to your gastroenterologist and get full imaging of your small intestine. You may have unmasked a Cow's milk allergy that was previously hidden. Please keep me posted of your progress.

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Bloating, hard stools and possible chronic constipation

I am in my early 20's and underweight and eat very little mainly due to the bloating that I experience if I eat other foods and have hard, pellet-like stools as well as back pain (bone pain) and have many other symptoms of celiac esp. when eating high-fat foods or cereal like wheetabix. I had done a barium study many years back and came out negative. My blood test is normal. I also went to see a GI and got tested for celiac (fasted and took laxatives the day b4 the test as preparation) - it came back normal. But here's the thing -when I got tested for celiac, my DAILY diet consisted strictly only of 1 glass of 1% milk, a fruit (peach/nectarine), and 2 slices of white wonder bread w/ jam. Could this be the reason it could have turned out negative - I mean should I have eaten things containing more gluten (ie. wheatabix) before the test?

You were ingesting enough gluten with the 2 slices of Wonder bread to make a celiac test positive if you really have celiac disease. It sounds as if you have either constipation-predominant IBS, or just chronic constipation. Have your gastroenterologist try Zelnorm, or Miralax, or Amitiza.

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Bloating and discomfort following Beer drinking

For 6 years, I prepared a strict gluten & casein free diet for my son with autism. That was fine to do, as he was a child & I could control his food. Recently, my husband has bouts of bothersome gastrointestinal bloating & discomfort (sometimes pronounced discomfort), also gas and diarrhea. This lasts sometimes for several days. Sometimes the occupancies are rather frequent, yet sometimes not. As he's observed the pattern, he is certain that he responds this way to beer (he's a not so frequent beer drinker), and now he suspects food to be the culprit. He had never been on-board with my gluten & casein free diet for my son (although he never interfered with me implementing it). Now, he's looking at food in a whole new way. He's eliminated beer and I'm baking & cooking gf. Is it beneficial to simply reduce gluten in the diet, or, as in autism, must he eliminate it to restore himself to good gastrointestinal health? I want his eating habits to help prevent further deterioration in his system. However, he's in sales & not home for meals often. I don't think he'd chose to go 100% gluten free.

He may not necessarily be gluten-sensitive; he should get tested. He may have IBS, and this could respond to low doses of bowel anti-inflammatory drugs like balsalazide. He really needs to be evaluated by a gastroenterologist.

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Accuracy of IgA and anti-tTG tests versus HLA-DQ2 and HLA-DQ8 genes

I am a 35 year old female who was diagnosed with Celiac disease at age two. I now have identical twin girls and up until 8 months ago had kept them on a gluten free diet. Once they were introduced to gluten for a couple of months their doctor did a blood test for celiac and it can back negative. Then last month my one daughter has had a change in her bowel movements. The color had gone from brown to greenish and very smelly. She has had no other complaints. Should I be concerned that she might have celiac?? Do I need to get my daughters re-tested at some point?? And when should that be? And what are the chances that they do have celiac because I have it?

If your doctor did an IgA anti-tTG test, it may not be as reliable as has been noted in the literature, as those numbers of reliability come from research labs. Recent studies have shown a sensitivity of only 40% with commercial labs. That said, a test for HLA-DQ2, HLA-DQ8 genes is much more reliable in the setting of your daughter's situation. If any of those are positive, then you and your husband should be tested for those genes as well, and then one could determine the inheritance.

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No bowel movements for 14 days after Colonoscopy

14 days ago my brother had a colonoscopy test and since then he has not had a bowel movement. He has taken enemas and drinking prune juice and still can not go. Is it a reason why he has this? My brother has MS. Please advise.

Your brother may have had an exaggerated effect of the sedation used in colonoscopy upon the nerves controlling gut motility, perhaps due to the MS. Why did he have the test to begin with. Was it because he was having bowel symptoms? He needs to see his gastroenterologist, as there may be medications to reverse the problem.

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Occasional bright red blood in stool

I'm a 27 year old male. I have had a colonoscopy and an upper gi. Both came back normal. I still continue to have bright red blood in my stool from time to time and I don't want to have more useless tests done. It is extremely confusing. Could this be caused by food allergies or is the only possible explanation something physiological. Please help.

You most likely have either an anal fissure (tear), or a small hemorrhoid. These are caused by a combination of too much tension in the muscles of the pelvic floor that surround the anus, producing resistance to the passage of the stool, a hard stool that requires straining to pass it, and that favorite indoor male activity-reading on the throne (toilet seat)! Fissures heal quickly, and are often missed at colonoscopy. This is definitely not food allergy. Don't sweat it, just eat plenty of fresh fruits and veggies, exercise, drink fluids, and don't read on the "throne". Warm tub baths before bedtime can relax the pelvic floor muscles. For more detail go to our book "Gut-Check: Your Prime Source for Bowel Health and Colon Cancer Prevention" (authorhouse.com 2001, Jeffrey Aron and Harriette Aron auths.-available on amazon.com.

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One stool every 3 days - is that a problem?

Hi, I'm a 16 yr. old male, and I wanted to know if 1 stool in 3 days is bad. I saw a program on TV about some "cleansing of the colon" and the doctor had said something along the lines that having 2-3 stools a day was normal. I weigh about 150 pounds and I don't eat as healthy as I should. It just doesn't seem right that I can eat 9 meals in 3 days and only go to the bathroom once or twice. If you could help me in any way as far as informing me on what's going on, I would very much appreciate it.

That question is addressed in our book, "Gut-Check: Your Prime Source for Bowel Health and Colon Cancer Prevention" available on amazon.com. To be brief, if you do not have to strain to have a bowel movement, and if the stool itself is soft and well-formed, then the range of normal is 3 a day to 3 a week. If you are not eating adequate fiber and consuming adequate fluid, and are sedentary, you will eventually have problems. Our book (Jeffrey M Aron MD and Harriette Aron, co-authors) has a detailed diet that will help you.

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Nightly bloating and palpitations following Alcohol and food

I am a 34 year old male in decent shape. I often wake up in the middle of the night very bloated with heart palpitations. This always occurs if I have eaten or consumed alcohol. These symptoms have occurred in the last year or so. I have taken myself to the ER on several occasions thinking I was having a heart attack. I was sent home every time with little explanation. I have seen my doctor and he has prescribe Nexium. This does not seem to work. Lately it does not seem to matter what I eat with out experiencing these symptoms. Alcohol definitely makes it worse. I have had my heart tested with a Nuclear stress test and passed with flying colors. It almost feels like the gas or bloating in my chest changes my heart rhythm. What do you think?

See your local gastroenterologist who will test you for acid sensitivity and motility of your esophagus. You may need other types of medication to control your problem.

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Diagnosing Autoimmune Enteropathy versus Celiac Disease

My 21 month old daughter was just tested for Celiac Disease (blood screening only) and the results showed that she most likely has the disease. Her Serum IGA was 219 which is normal. Her Antigliadin IGA was over 100 and her Tissue Transglutaminase was over 100. The gastroenterologist said those numbers were very high and that she is pretty much convinced that she has Celiac because of the test results. However, she still wants to do the biopsy to confirm it. My husband and I are very concerned about doing this because she is so young. I'm wondering, do you think it is really necessary since the blood tests show that she most likely has it anyway? The biggest symptom she has is a very bloated/distended hard belly. She also has pale smelly stools and they range from clay-like consistency to very pasty. She has been vomiting over the past couple weeks.and it is only once when she does it and always in the evening before bed. She doesn't vomit every day. The first week it was 4 out of 7 days, and then she didn't get sick for a whole week. I switched her to Lactaid after her first week of vomiting and it seemed to help because she wasn't doing it anymore. But last night she just threw up again. Other symptoms she has are irritability, gas pains (I can hear it moving in her belly and feel it when I lay my hand there), decreased appetite (but she's still a good size -- 27lbs), and sometimes she's very tired when I don't think she should be. She also had an ultrasound done to rule out any masses on her kidneys, etc. All of her organs appeared to be fine and functioning normally. There was a LOT of activity in her bowel that we could see on the screen, but I guess the radiologist didn't seem to think much of it because it wasn't mentioned when we got the results. Along with the blood tests for Celiac, they did a CBC and also tested for Anemia. Those results came back normal. They said her iron levels were actually pretty good. That tells me the disease can't be causing too much damage yet other that making her very uncomfortable. Anyway, I'd like to get your opinion on what we should do. We really don't want to do the biopsy unless there is some other reason it should be done other than to confirm the diagnosis. The GI mentioned they would also be looking to rule out something called Refractory Sprue and Autoimmune Enteropathy. I read that no one under the age of 20 has ever been reported as having Refractory Sprue and I couldn't figure out what the other thing was. From what I could find, it just sounded like another name for Celiac Disease. Lastly, I read that these tests often come back inconclusive - especially for children as young as she is. Aren't they just going to tell us to try going gluten-free whether the test comes back positive or inconclusive?


Your doctors are just trying to be 100% sure. However, your daughter cannot have "refractory sprue" since she has not yet been on a gluten-free diet. Many authorities would argue that the very high levels of anti-tissue transglutaminase antibodies and a normal IgA level are sufficient to make the diagnosis of celiac disease. The biopsy findings in autoimmune enteropathy are indistinguishable from those seen in celiac disease. One would approach treating so-called autoimmune enteropathy first with a gluten-free diet anyway, so I would advise going ahead with a gluten-free diet for at least 3 to 6 months, and follow the levels of anti-T2g and the clinical response. I would not opt for the biopsy at this time.

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Time it takes for Celiac Disease blood test results to come back

I was diagnosed with IBS over 15 years ago. I recently had an appointment with my GI for a colonoscopy, and after giving her my medical history, including the symptoms of my IBS, she asked if anyone had ever tested me for celiac disease. I have now had that blood test done. How long does it take for that blood work to come back?

In most instances, antibody tests for IgA anti-tissue transglutaminase will be available in a week. If you did HLA testing, it may take two weeks, depending on the lab, and how often they run the tests.

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Pain in upper abdomen

Sometimes I have pain in my upper abdominal area and it feels like someone punched me in the stomach. Do you know what this is?

Without knowing more about you and other symptoms you may be experiencing, this question is too broad to answer. I recommend that you go see your doctor!

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What is CD3?

I had blood work done and I wanted to know what CD3 means. Mine is 1852. The range is 650-2500. I wanted to know is mine in the normal range?

A CD3 cell is an activated immune cell. Getting a blood level of CD3 cells is of no value in celiac disease: if there is an increased level of CD3 cells in the lining of your small intestine, then that would correlate with celiac disease, especially if you have had an abnormal celiac disease blood test.

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Ways to confirm diagnosis of Celiac Disease

I had blood test done for Celiac's almost two years ago and the tests pointed towards Celiac's but my doctor determined it was IBS. I continued to experience stomach issues and sought the help of a chiropractor and a cleansing program. I have been off wheat, dairy, and just about everything else but rice, chicken, veggies and fruit and feel soo much better. I have questioned my doctor about the previous Celiac testing and asked if this would be something he would want to pursue and he said definitely. Now that I have been off the wheat products I know the likely hood of the tests coming back positive would be slim so I would have to go back to eating wheat products for a while before being tested. My question is if my blood tests already pointed to Celiac's, can they do the biopsy and find damage done or do I also need to be eating wheat products for that test to confirm Celiac's also? Thank you for your help. I have not been able to find the answer to this question anywhere.

You do have celiac disease. Repeat the blood tests, and, if they have returned to normal, or if the titers of anti-tTG antibodies have fallen (by the same lab that did the initial tests), then that would confirm the diagnosis without a biopsy. On the other hand, you may have had an advanced celiac lesion had a biopsy been performed initially, and may not have returned to normal in the time that you have been avoiding gluten, in which case a biopsy could still be abnormal without further restricting gluten. If your doctor refuses to do the biopsy, go see another gastroenterologist and get a biopsy.

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Why is gluten so bad for your health??

Remember that, given the most generous estimates of the incidence of celiac disease, the vast majority of people tolerate gluten quite well. If you are among the one out of a hundred or so who is sensitive to gluten, then you have a genetically-driven reaction to protein fragments in wheat, barley and rye that will cause your immune system to damage various parts of your body.

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Connection between Celiac Disease and isolated nerve damage

Is there any connection between Celiac Disease and toe neuropathy? I have seen articles regarding this, but when I ask the doctor, I do not get a definite response.

While celiac disease is known to be associated with many kinds of nerve damage (neuropathies), an isolated "toe neuropathy" is unusual. One would expect a more widespread distribution, if celiac disease were the culprit. I would pursue a more localized problem with my neurologist.

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Fresh blood in stool that responds to Prilosec.

Hi. I am a healthy 19 year old that does not smoke or drink. Starting back in January, I began to have dull aches in my lower abdomen when I would wake up like I had been doing crunches in my sleep. Also for about two weeks there was bright red blood on my toilet paper after I wiped. During this time I did have increased stress with the birth of a baby, moving, change of diet, stressful job, and start of very difficult classes in spring semester. Around March when symptoms were getting pretty bad with bouts inconsistent stool appearances, diarrhea, constipation, and pressure in lower abdomen, I visited a doctor and he found blood in my stools. He thought it may have been an ulcer so I took Prilosec OTC for about a month and a half and symptoms did get better, almost completely went away except the morning stomach pains. Went back to the doctor and he took me off Prilosec and a few weeks later after symptoms came back gave me a blood test for H. Pylori which came back negative. After getting off the medication the pain got pretty bad again, sometimes I could feel it right through my back, and my stools became inconsistent again, sometimes pale, sometimes dark. The doctor said I should try to reduce my stress and I would probably feel better but would refer me to a GI doctor if necessary. Since I am so young and there is no history of colon cancer in my family I really don't think that is what it could be but am really worried about it. Right now I do not have health insurance and even if I got some at this time, the condition would not be covered since it is a pre-existing condition. I would have to wait about 5.5 months to sign up for this not to be a pre-existing condition anymore. I have a good amount of money saved up and am willing to visit a GI doctor for this since I am so scared it could be something serious. Could it just be IBS?

The bright red blood in your stools is not due to an ulcer, but is most likely from a hemorrhoid or a fissure in the anus, probable "gifts" from childbirth and stress. The chances of colon cancer are extremely rare. I would advise staying on the Prilosec OTC until your insurance kicks in, then see a gastroenterologist. In the meantime, take about 10-15 minutes every day to stretch, deep breathe and relax; maybe take a nice warm bath at bedtime, and get someone to help out with the baby. Plenty of fluids, fresh fruits and veggies and whole grains ( I don't think this is celiac disease), and you should be good.

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Positive blood tests bur negative biopsy for Celiac Disease

I had a Celiac Panel blood test done that says I tested positive for Celiac. My gastro doctor did an intestinal biopsy and Celiac was ruled out. What would cause my blood tests (IAG, IGG, etc.) to show positive, but the biopsy says no? Can you explain?

You still may have celiac. There are several studies (the latest is by Salmi TT et al in Gut April '06, Kaukinen K et al Scand J Gastroenterol 2005 40:564-572) that show deposition of anti tTG antibodies in the intestinal mucosa without villous atrophy. In addition, the pathologist should stain the biopsy for CD3 cells and count the number of them per 100 intestinal cells each over 5 villi. If there are more than 20-25/100, then the biopsy is abnormal, a so-called Marsh I lesion: one that looks otherwise normal. Finally, HLA testing for DQ2 and DQ8 genes should be done, if any of these are positive, then you have celiac disease. If all the above are negative, then there are other inflammatory/autoimmune diseases that can make the antibody tests positive.

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Improvement of advanced lesions related to Celiac Disease

2 years ago, through a biopsy I found out I had celiac disease. I had been feeling very bad, I gained around 35 pounds in 3 months, I had big stomach pains, flatulence, bloating, constipation, I did my blood tests and I also had big anemia and other things that I do not know how to translate in english , as I live in Romania. Here we can not do the genetic tests that I read on your site, but at the biopsy, they told me my intestine was completely flat (so i guess Marsh III or Marsh IV). I have been keeping the GF diet ever since and I felt very good. I did my blood tests 4 months ago, and I wasn't anemic nor anything. My stomach symptoms disappeared besides constipation. Should this be a sign I am not keeping the GF diet correctly? Should I repeat the biopsy?

You are making great progress. Since you had an advanced lesion on biopsy (MIII or IV), it will take some time for everything to return to normal. A repeat biopsy after a year of a gluten-free diet may only improve to a MII, or even a MI stage. That means there is still some healing to go, but you will be better. In the meantime, consider Miralax on a daily basis for constipation, it is the same solution that is used to prepare for colonoscopies, but used daily in much smaller doses. Best wishes for great health!

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Metamucil and other sources of soluble and insoluble fiber

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?

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!

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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Colon cramps for 20 years - could it be IBS or Celiac Disease?

I am 64 years of age, have had infrequent but very painful colon cramps for at least the past 20 years - not associated with constipation, stress or any particular food (we shun wheat anyway) that I can identify or associated with anything else that I can imagine. The episodes seem to come out of the blue. Less than a year ago I had a colonoscopy (after all, I am getting older), which was clear of fibroids, diverticulitis/osis or any other peculiarity.

As my dear husband seems to "take on" most any symptoms that he hears about, I never did tell him about these debilitating occurrences. But lo and behold, about 2 years ago he faced the same dragon for the first time. Personally, I don't worry about it happening to me, as if something untoward were going to happen, it surely would have by now. But my husband worries terribly. His colonoscopy has also turned out fine. My attempts to sooth him have gone in vain. Can you give us a likely cause of these very miserable cramps? Jeepers, at least a labor pain releases in 2 minutes or less!

I hear stories like yours and your husbands' at least twice a day. There are two probable causes to both of your problems: Pain predominant Irritable Bowel Syndrome, or undiagnosed celiac disease. Because you have been wheat free, you are not gluten free, so both you and your husband need to be tested with at least an IgA-anti-tTG, a total IgA and, if negative, with genetic testing for HLA-DQ2 and DQ8. If any of those are positive, then you each need an upper g.i. endoscopy and 8 duodenal mucosal biopsies to be stained for CD3 cells, and 500 epithelial cells counted for CD3/100 epithelial cells. If there are more than 25/100, then you both should be on a strict gluten-free diet. Recent evidence is rapidly mounting that IBS is also an inflammatory disease of the gut. The inflammation is not as severe as in other inflammatory diseases such as Crohn's disease and ulcerative colitis, but rather more subtle, often missed at colonoscopy and biopsy, but nonetheless disruptive of the way the nerves, muscles and hormones of your gut function. There is preliminary evidence that treatment with very small doses of gut anti-inflammatory drugs such as balsalazide and mesalamine could be your answer. Check this out with your gastroenterologist.

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How long does it take to get wheat or gluten out of your system?

No one knows for sure, but given the digestive rate, absorption of gluten and glutenin peptide fragments, and the turnover rate of the intestinal cells, about 3-7 days would be a rational guess. How much time it takes to recover from damage done by gluten, however, depends on a number of factors: the dose of HLA DQ2, DQ8 genes that you receive from your parents, the position of the genes of chromosome 6 (genes on the same side of the chromosome-"cis" position are more potent than on opposite sides of the chromosome-"trans" position), the reactivity of your innate system at the level of the intestinal cell, and on the adaptive immune system's pre-programmed drive. That said, the more advanced your biopsy (Marsh III), the longer it will take to completely reverse the disease. Marsh III's take about 2 years, while Marsh I's may take 6 months to a year. All the more reason to have a biopsy at the time of initial diagnosis, and another one one year after being free from gluten.

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How accurate are the blood tests for celiac disease?

The commonly used antibody tests (IgA anti-gliadin and anti-tissue trans glutaminase) can diagnose about 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.

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What is the link between celiac disease and cancer?

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; MarshIV 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.

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Can a 5-week old baby develop Celiac Disease?

A baby 5 weeks old while only on breast milk 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 breast milk 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.

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.

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Testing for Celiac Disease for people taking steroids

I want to get tested for celiac disease but I am on steroid medication for asthma and another condition I have. Won't this affect the blood test results since steroids suppress the immune system?

While it is true that the antibody responses to gluten and tissue transglutaminase are diminished in those on steroids and other immunosuppressives, it is still worthwhile to get them, as any abnormality would lead to an intestinal biopsy. If they are normal, then get tested for the genes: HLA DQ2 and DQ8. If these are negative, then you don't have celiac disease. If either one are positive, then get an intestinal biopsy, and have it stained for CD3 cells and read by a pathologist experienced in celiac disease.

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Difference between Celiac Disease and Gluten Intolerance

What is the difference between celiac disease and gluten intolerance? Is one more serious than the other?

The strict definition of celiac disease -- positive antibodies to gliadin, intestinal endomysium, and tissue transglutaminase, together with the presence of HLA-DQ2 or HLA-DQ8 genes and an intestinal biopsy that shows at least 20-25 CD3 cells per 100 epithelial cells -- will account for about 95-98% of all those sensitive to gluten. It must be noted, however, that there are injurious grain proteins that cause damage and produce symptoms by mechanisms that are as yet obscure. As well, many other gene markers for grain-mediated injury have been described, thus placing many into the category of gluten intolerant, but not truly having celiac disease. We do know the consequences of untreated celiac disease -- an increased risk for lymphomas and other solid tumors, along with a host of associated auto-immune, neurological and endocrine diseases. It is unclear whether other people who are not celiacs but clearly cannot tolerate gluten are at risk for any other associated diseases. If you test negative for the strict criteria for celiac disease, but still cannot tolerate gluten, there is no harm in keeping to a gluten-free diet.

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Would a person with Crohn's disease also benefit from a gluten-free diet?

This question has arisen many times in my practice, and it stems from the notion that Crohn's disease, and for that matter, most of our Western diseases, could be traced to the introduction of refined and processed foods into our diet. As well, Celiac and Crohn's disease share many analogous immune-mediated mechanisms. That said, one must be very careful not to make a blanket recommendation to exclude gluten from Crohn's patients, as it will remove the vast majority of them from vital nutrition. To be more confident in recommending gluten exclusion for Crohn's patients, one must go through the gamut of full immunologic and genetic testing, and pursue small intestinal biopsy if necessary. If these show a positive response, then gluten should be excluded.

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Importance of genetic tests and careful biopsies in diagnosing Celiac Disease

My husband (whose mother had celiac disease) eliminated gluten from his diet and feels much better, but since he never had a biopsy, I am concerned that he may have damaged intestines or is not absorbing nutrients even though he is watching his diet. What kinds of other testing should he have in order to see how his "insides" are and to make sure that he doesn't have osteoporosis or other nutrient deficiencies?

Your husband should obtain testing for the genes strongly associated with celiac disease -- HLA DQ-2, and DQ-8, to confirm the diagnosis. An intestinal biopsy may not reflect poor absorptive function as most celiacs do not have major malabsorption, but it could confirm the diagnosis in the hands of a skilled pathologist. A bone density test will be crucial in determining bone loss. Treatment with vitamin D and calcium could be crucial in preventing any bone loss. Basic blood tests like a CBC, albumin, prothrombin time, cholesterol and urea nitrogen will give you an idea of nutritional status and reserve. Most doctors, and certainly all gastroenterologists should easily run these tests for your husband.

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Differentiating between IBS and Celiac Disease

I was diagnosed with Irritable Bowel Syndrome (IBS). Is it possible that I could actually have Celiac Disease?

Most certainly. Studies have shown that about 30% of patients with diarrhea-predominant IBS, and a significant, but lesser percentage who have constipation, bloating, pain and alternating forms actually have Celiac Disease. There are many celiacs in my practice who came to see me because their "IBS" was not responding to any treatment, but have made complete recoveries when diagnosed and placed on a gluten-free diet.

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Diagnosing Celiac Disease

I have some of the symptoms that are related to Celiac Disease. How do I find out if I have it or not?

Ask your gastroenterologist or internist to contact Prometheus Labs in San Diego, and arrange for them to run a panel called "CELIAC PLUS". This will test for all of the antibodies to gluten and your own intestine, and, if negative, the lab will automatically test for the genes associated with Celiac Disease. If any of these tests are positive, then obtain an intestinal biopsy from your gastroenterologist, and make sure that the pathologist reading the biopsy can stain for CD3 cells, and count the number of these cells per 100 epithelial cells. Most authorities feel that more than 20CD3/100epith cells is abnormal. These findings occur long before blunting of the intestinal villi develops, which is what a less-experienced pathologist would be looking for on a biopsy. So if blunting of the villi are required to make a positive diagnosis, many celiacs will be missed.


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