Gluten-free diet may not be necessary
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. Why don’t doctors suggest this to their patients?
B.S.
Answer: There are three reasons I am cautious about recommending that people stop eating gluten without making a diagnosis first.
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.
Secondly, a placebo response from a major dietary change like going glutenfree can be powerful. 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.
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?
K.B.
Answer: 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.
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.