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Should Doctors Ignore Body Mass Index to Better Diagnose Celiac Disease? 03/19/2012 - A clinical gastroenterology research team recently weighed in on the practice of using weight as a factor to screen for celiac disease. They are calling for doctors to ignore body-mass when assessing patients for possible celiac disease screening.

The team was made up of Fabio Meneghin, Dario Dilillo, Cecilia Mantegazza, Francesca Penagini, Erica Galli, Giulia Ramponi, and Gian Vincenzo Zuccotti. They are affiliated with the Department of Pediatrics of the Università di Milano Luigi Sacco Hospital in Milan, Italy.

Photo: CC - Newbirth35The team argues that, more and more, people with clinical celiac disease are presenting widely varied symptoms, while classic gastrointestinal symptoms like diarrhea or failure to thrive are becoming less frequent at diagnosis.

In fact, data shows that symptoms once considered to be atypical are now appearing at least as often as classical symptoms related to nutritional malabsorption.

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Recent studies and case reports show that the expected clinical-condition of malnutrition, typical in a disease where there is a disorder of absorption, is less frequent than in the past. Meanwhile, overweight and even obesity are increasingly common in people with as yet undiagnosed celiac disease.

The team points out that obesity has become the most prevalent nutritional disorder among children and adolescent of United States, and also in many European countries. They note that a rates of overweight and obesity have doubled in a single generation.

They use these facts to encourage doctors to screen for celiac disease without regard for the patient’s body weight, and thus speeding diagnosis and avoiding possible clinical consequences for patients.

For now, their call has been rejected by the editors of Gastroenterology Research and Practice. However, look for this kind of call to be echoed in the future, as data are compiled, and the realities of celiac disease are better understood.

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13 Responses:

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said this on
19 Mar 2012 9:12:48 AM PST
I'm overweight and have celiac. I'm sure my primary care doctor had no thought of celiac as a possibility - he just sent me to a gastro to be checked because of anemia. Thank goodness she didn't dismiss celiac as impossible because of my weight.

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said this on
26 Mar 2012 12:26:18 PM PST
I'm overweight and have celiac. I had to diagnose myself and push my doctors to do the tests because it was not ever suggested despite the fact that I have 2 other autoimmune diseases and presented with gastrointestinal distress on more than one occasion. After I learned about celiac, and was diagnosed, I decided my doctors were all idiots.

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said this on
27 Mar 2012 1:06:58 AM PST
I'm overweight and have celiac. I had to diagnose myself and push my doctors to do the tests.
Same as Wendy.
When I asked the doctor of the possibility of CD, she said: "no way, you are overweight!"
After the tests, she said: I didn't imagine this. You were right

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said this on
27 Mar 2012 5:56:32 AM PST
I too was overweight (over 300 pounds) when my anemia was determined to be celiac. I only had 1 doctor who was very surprised by this because of my size. The rest just accepted it, and have learned a lot more about bizarre symptoms I had that disappeared when I figured out that I am also lactose intolerant. My primary is now on alert for things that as a celiac I am more likely to develop (like cancers). This can only help me and her other celiac patients as time goes on.

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said this on
27 Mar 2012 8:44:28 AM PST
I am obese and have celiac disease. When my doctor sent me to the specialist for a biopsy to confirm my celiac diagnosis, the specialist looked at me over the top of his glasses and said, You don't have celiac disease. Turns out I did and my only symptoms were fatigue and heartburn (for which this same specialist had me on Nexium for many years). Once I went gluten free, the heartburn went away.

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said this on
31 Mar 2012 7:04:45 PM PST
I too have found the same scenario regarding heartburn and acid indigestion! No gluten, No heartburn!!

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said this on
27 Mar 2012 10:56:19 AM PST
I have two sons. Both diagnosed with celiac. One was 18 lbs at his 12 month check up full term very large birth weight. I was 125 and gained 29 lbs with him, and healthy. Other son with celiac was 35 lbs at 12 month checkup. I was 126 before my pregnancy and gained 31 lbs. My point is this research is accurate. I know this, have seen the size fluctuation along with how my two boys both react differently to the same disease. It is silly to me that smart people are at times the most ignorant.

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said this on
27 Mar 2012 1:30:52 PM PST
My gastro doctor told me to tell my family members to get tested. He said it is standard procedure. So they asked to be tested, but their doctors refused to test them. Their doctors said there weren't enough symptoms.

( Author)
said this on
27 Mar 2012 2:19:46 PM PST
Keep in mind that most celiacs have no symptoms, but the risks are the same whether you have symptoms or not.

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said this on
01 Apr 2012 9:33:27 PM PST
Early in the disease, there may be NO symptoms or the symptoms are so varied that a number of diseases mimic them. If another family member has celiac, all first and second generations should be tested if any symptoms are evident. Finding the disease early could prevent a world of hurt later on in life. Sometimes symptoms are so vague initially, they aren't even mentioned to a doctor. Or it may appear that the symptoms are totally unrelated. Only later, when a diagnosis ( or IF a diagnosis) is made, does anyone look at the "big picture." A disease should never be discounted based on what is typical with Celiac--there is no typical. It can affect any organ of the body and in many different ways. I am Celiac, but also have severe sleep apnea. I was recently in the hospital and a gastroenterologist came into the room, saw my C-Pap and asked why it was there. He told me "I couldn't have sleep apnea because I am too thin." During my sleep test I stopped breathing 236 times in one hour. My husband had gotten to the point he couldn't sleep in the room with me until I got my machine. Point is, many doctors make snap decisions based on a person's appearance. CHANGE doctors if you suspect that!

Sharon Mc
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said this on
30 Mar 2012 6:37:52 AM PST
The ignorance among physicians today about the changing (if not changed) face of celiac disease is astounding. Yesterday, I was, however, overjoyed that my ophthalmologist who noted my longstanding low-level eye inflammation (had had severe bouts over the years) had cleared since my last visit (I am now 5 months + 2 wks gluten free!). I also noted to him that I have had some accidental contamination issues, and that carrageenan (thickener/additive in many foods, esp. low-fat dairy, soy, other non-dairy milk products) definitely causes me similar inflammatory symptoms, as it does to many other celiac and gluten sensitive folks. We talked about finding a website or biochemistry dept at universities that might be able to provide the AA (amino acid) chain sequence for carrageenan (red seaweed) and even brown seaweed (kombu) to see if these are similar to that of gluten-gliadins. He noted that he would definitely think about a celiac or gluten-sensitivity issue with his patients who have inflammatory eye issues and/or other medical history symptoms similar to mine! Meanwhile, I cannot breakthrough to my children’s pediatrician to make this connection!

I will read the GI article itself, but I can tell you after finally being diagnosed in my near-mid fifties - and having underweight problems as a young child - then obesity (doctors told me to eat-eat-eat to address my childhood anemia) then close to two decades of normal weight (yup infertility, anemia, Vit/mineral deficiencies, etc.) back to obesity - there is a healing time needed before weight loss can be achieved. Despite having no thyroid issues (and my doctor keeps testing because there is a family history and an association with celiac disease), the scale would not move for months (prior to my diagnosis it took me 2 year to take off 20 lbs! I now know the reason!). Recently, I broke through the barrier (granted adjusting down carbs then increasing was a critical piece) such that my healthy food plan and exercise is starting to reverse the inflammation and metabolic slowdown caused by the disease - both if which are needed to get the weight off. Patients need to understand this. Physicians need to understand and be patient with their patients! Folks may well be doing everything right, but the body needs time to heal and respond.

Sharon Mc
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said this on
30 Mar 2012 7:17:05 AM PST
And of course, "their call [to screen for celiac regardless of BMI] has been rejected by the editors of Gastroenterology Research and Practice" as these children can be future gastric bypass candidates! (I asked my nutritionist who works primarily with gastric bypass folks - if they routinely screen for celiac among candidates - nope! What a surprise and what ignorance - but then again it seems this may be intentionally ignored.) Just as diagnosing the disorder or the more controversial gluten sensitivity can lessen, or even eliminate, the drugs folks are taking for associated disorders, does not benefit the drug companies! Screening for celiac disease does not benefit the bottom line for many gastroenterologists.

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said this on
08 Apr 2012 9:45:10 AM PST
I'm an old fashioned guy in everything, and in this issue. I'm the thinnest man I know. Gluten intolerance.

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