A few weeks ago in the New York Times there was a “Think Like a Doctor” challenge from
Lisa Sanders, MD, where she outlines a case and asks readers to respond with further testing
they would perform and possible theories on a diagnosis.
There were almost 450 posts and very few pursued a gluten issue or Celiac Disease, which
is what the case turned out to be, even though previous testing did indicate elevated antibodies
to gluten. The issue that seemed to throw people off was that it was stated that the patient had
tried a gluten free diet and did not experience any improvement. This is where a detailed intake
and not rushing through a history can be so important.
This patient did try removing some gluten foods from her diet, but perhaps did not understand
the various sources of gluten, nor the hidden sources. Additionally, many people with Celiac Disease
or gluten sensitivity are also sensitive to other grains that are often used as substitutes for gluten
containing grains. If these “non-gluten” grains do react (even to a lesser degree), the patient may
not experience the improvement expected and gluten will be ruled out.
Wheat in the United States has been dramatically modified over the past 5 or so decades and is not
the ancient grain it used to be. The way wheat is stored and processed also contributes to why more
people are experiencing symptoms when consuming wheat products.
Symptoms can be extremely varied, leading to an increased complexity in diagnosis. Common symptoms
include: headache, stomach pain, bloating, gas, belching, brain fog, mental sluggishness, acne, obesity,
diarrhea, constipation, skin rash, neurological dysfunction, depression, anxiety, moodiness, muscle pain,
poor digestion, nutrient deficiencies, seizures, migraines, thyroid and sex hormone dysfunction, PMS, the
list is virtually endless.
Just because you have been tested (in the NYT case the patient had an upper endoscopy – thought to be the
gold standard in medicine), and the results come back negative, it does not really mean that you don’t have
a gluten issue or possibly even Celiac Disease. There are many reason why antibody levels may not be elevated,
why biopsies may not be accurate, or even why the results were misinterpreted. There are many more false negatives
with gluten or Celiac testing than false positives.
If you continue to have symptoms that do not resolve, or your doctors begin to tell you it’s “in your head”, visit with
another professional who can help you understand the complexities of gluten sensitivity and Celiac Disease.
Dr. Slavin is an adviser to the Eagle County Gluten Free and Celiac Disease Support Group. She has extensive training
in gluten sensitivity and other bowel dysfunction. If you are experiencing digestive problems, call Functional Wellness
today to talk with Dr. Slavin.
The details of the case: http://well.blogs.nytimes.com/2011/10/26/think-like-a-doctor-ordering-the-right-test/