Dear Dr. Roach: For several months I was having constipation, diarrhea, stomach cramps, dizziness and a general feeling of unwellness. It got so bad that my gastroenterologist sent me for a CT scan and colonoscopy, which both turned out negative. Finally, my daughter said, “Mom, I’m sure it is gluten intolerance.” Sure enough, in just a few days of staying away from gluten, I was feeling so much better. Now I don’t eat anything with gluten in it and I am fine. Why don’t doctors suggest this to their patients?
There are three reasons I am cautious about recommending that people stop eating gluten without making a diagnosis first.
The range of symptoms a person can have with celiac disease is broad, from none (or almost none), to mild discomfort after eating, to the symptoms you have, to a life-threatening wasting away. The antibody testing we have now is much more accurate than it used to be. So first, I recommend an antibody test while a person is still consuming gluten.
A positive test is recommended to be followed up by a small bowel biopsy, which is done via an endoscope. The antibodies can go away completely (and even the biopsy can become normal) on a gluten-free diet, so you can miss your chance to get a diagnosis.
Secondly, a placebo response from a major dietary change like going gluten-free can be powerful. I am glad you feel better swearing off gluten, but that doesn’t 100% mean that you are gluten sensitive. Over half of people diagnosed with nonceliac gluten sensitivity tolerate gluten when they don’t know they are getting it. Many people in this situation are sensitive to FODMAPs (fermentable oligo-, di-, and monosaccharides and polyols), which are reduced on a gluten-free diet.
Finally, maintaining a strict gluten-free diet is hard, and may not be necessary. I’m not sure whether you are just avoiding the most obvious sources of gluten, or whether you are compulsively reading labels, which is what a person with celiac disease must do.
Dear Dr. Roach: I told my primary care physician that I have had a sore shoulder for several months. He ordered a shoulder X-ray. I got results back online, and it said that I had “sclerosis and irregularity consistent with chronic rotator cuff disease.” My next appointment with my doctor is months away. What is rotator cuff disease, and can I exercise to fix it?
The rotator cuff consists of four muscles and their tendons, which help to provide stability to the shoulder. The rotator cuff, whether through tears or inflammation, is a common source of shoulder injury. The diagnosis of rotator cuff disease is generally made by a history and physical exam, and the X-rays do not always make the diagnosis. Bedside ultrasound is a newer technique that helps. MRI is used when the diagnosis is uncertain and surgery is contemplated.
Treatment depends on the underlying cause of the rotator cuff disease. A full-thickness tear of a rotator cuff tendon usually requires surgery, while tendinosis and partial thickness tears are usually treated by rest, anti-inflammatories and physical therapy. I wouldn’t recommend exercises until you complete a full evaluation and are prescribed the correct exercises for your specific issue.
Months is too long to wait, as untreated rotator cuff syndrome can lead to a frozen shoulder.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu