Gluten-Free: To Be or Not To Be, That is the Question

Recently a young woman came to our office with multiple complaints. She had extreme fatigue, difficulty sleeping, overall body and joint aches, and numbing and tingling in her arms and legs. She had seen multiple physicians, including a rheumatologist and neurologist. All studies were negative. She was told she might have fibromyalgia and given an antidepressant, which she refused to take.

On further questioning, this patient also told us that she had a history of irregular periods and was told to take iron for anemia.

This patient sounded like a patient with Fibromyalgia and Fatigue Syndrome. However, after a careful review of all her prior studies, we began to suspect Celiac Disease, an autoimmune disease. An autoimmune disease is a disease where the immune system produces antibodies that attack the body. In Celiac Disease, the antibody is directed against gluten, which is a protein in grains.

This patient’s blood studies revealed an iron deficiency anemia, a B12 deficiency and Celiac Disease. Her primary care physician told her that she couldn’t have the disease as she had no gastrointestinal symptoms. Lucky for her, she didn’t listen to him.

For years, the medical community believed that in order to have Celiac Disease, a patient had to have gastrointestinal symptoms. Research has shown the only 50% of patients report gastrointestinal symptoms such as diarrhea, bloating or gas. The most frequent symptom reported is fatigue. Other symptoms include muscle cramps, joint pain, tingling in limbs, mouth ulcers and irregular periods.

We explained the diagnosis to this patient and offered her two options: to go on a strict gluten-free diet immediately or to get an intestinal biopsy. As going gluten-free is both psychologically and physically challenging, the patient opted for the biopsy, which confirmed the diagnosis.

Going on a gluten-free diet, a regimen of B12 shots, iron supplementation and other nutraceuticals resolved all of her symptoms. Her fatigue and sleep improved, her anemia resolved and for the first time in her life her periods were regular.

We routinely screen many of our patients for Celiac Disease. However, even in those patients who test negative or “borderline,” we ask many of them to go gluten-free. Many patients report an improvement in symptoms within 4-6 weeks and sometimes sooner. Today, there are literally hundreds of gluten-free options at supermarkets and restaurants.

Many physicians are now realizing that some people without Celiac Disease respond well to gluten-free diets. Many of our patients come to us thinking that they are allergic to wheat. Wheat allergy is extremely rare, however gluten intolerance is far more common. Therefore it is important to be tested prior to going gluten-free.

Dr. Dean Mitchell
Mitchell Medical Group, NYC & Long Island

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