Ask Bl KMk Ask Dr. Keith Roach M.D
Dietitian is important resource in treating celiac disease
DEAR DR. ROACH: I am a 78-year-old woman who was just diagnosed with celiac disease. I had an endoscopy in 2007 because I was anemic, and the doctor told me I had an ulcer that healed itself. This year I had an endoscopy because I again was anemic, but this time he did a biopsy, which came back as celiac. I have no dysentery or stomach pains, which are red lights for celiac; I have had inflamed joints for years, accompanied by dry skin. Is it possible that I have had this disease for years and was never diagnosed? My doctor told me not to eat wheat but never went any further than that. I have been educating myself about the disease. Who else would I see about this? Also, what would happen if I ate wheat by mistake? I also have been short of breath for years, but heart and pulmonary tests all come back normal. Could celiac be causing this shortness of breath? -Anon.
ANSWER: Celiac disease, also called 'gluten-sensitive enteropathy' or 'nontropical sprue,' is an uncommon but increasingly recognized condition caused by a reaction to gliadin, a protein found in gluten-containing grains, especially wheat, rye and barley. The spectrum of symptoms caused by celiac disease and its associated conditions is too broad for this column to cover comprehensively.
Not everyone with celiac disease has gastrointestinal symptoms, such as diarrhea and weight loss. Some people get mild abdominal pain and mood changes, and never put these together with their diet. At age 78, it's very likely that you have had celiac disease for many years. The anemia 10 years ago possibly was celiac-related, through iron deficiency. People with celiac disease are more likely to develop arthritis as well, and one skin condition, dermatitis herpetiformis, is so characteristic of celiac that a biopsy is not needed.
Shortness of breath is uncommon with celiac disease, but a severe anemia can cause it, as can one rare lung disease, pulmonary hemosiderosis, which often goes away on a glutenfree diet. Disease of the heart muscle itself is rare but more common in people with celiac disease.
Unfortunately, the dietary information you got was woefully inadequate, so I would strongly recommend a visit with a registered dietician nutritionist, who can give you much more information. Don't eat wheat: Proper care of this disease depends on meticulous avoidance of gluten, and even small amounts count. DEAR DR. ROACH: My doctor just tested me for high calcium, and my vitamin D was low. He put me on 12 weeks of 50,000 IU once a week. You said something in a recent article about high vitamin D. Why the difference? — A.K.
ANSWER: Unfortunately, I am confused by your vitamin D treatment: I suspect the vitamin D has nothing to do with the calcium. A high calcium level can be caused by many things, including faulty technique in obtaining blood (if the tourniquet is on too long, the blood can become more acidic, which makes the calcium level appear higher), but I mentioned excess vitamin D (a rare cause) and elevated parathyroid hormone levels in my recent column. A repeated high calcium level should get your doctor to check a PTH hormone level. A high PTH level almost always means a benign tumor of the parathyroid gland, which is often but not always treated surgically.
DR. ROACH WRITES: I solicited opinions about televisions in physician waiting rooms, and have the results of what readers wrote me. Ninetythree percent of respondents did not like them. Some suggestions included artwork or an aquarium instead; music (especially classical) to provide white noise and privacy; and 1950s television shows or informational shows with closed captioning.