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Should Patients With Morbid Obesity be Tested for Celiac Disease Before Surgery? 03/04/2013 - Morbid obesity is a common medical condition. In many cases, bariatric surgery is necessary. Although for decades celiac disease has been associated with chronic diarrhea and weight loss, and other classic symptoms, recent data shows that the clinical spectrum of celiac disease is extremely wide.

Photo: CC--fbellonA group of researchers recently reported on the benefits of diagnosing celiac disease during pre-operative work-up for bariatric surgery.

The researchers included Federico Cuenca-Abente, Fabio Nachman, and Julio C. Bai of the Department of Surgery and Department of Medicine at Dr C. Bonorino Udaondo Gastroenterology Hospital in Buenos Aires, Argentina.

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They reported on the cases of five morbidly obese patients diagnosed with celiac disease during preoperative work-up for bariatric surgery. Celiac disease was suspected upon routine upper endoscopy, and confirmed by histology and positive celiac disease-specific blood tests.

Interestingly, four of the five patients had no obvious symptoms. One complained of chronic diarrhea and anemia. All patients began a gluten-free diet. Due to their celiac disease diagnosis, doctors offered all five patients a purely restrictive bariatric procedure. At the time of the report, three of the patients had received a sleeve gastrectomy, while the other two were still undergoing pre-operative evaluation.

The team's findings help to enlarge the clinical spectrum of untreated celiac disease. Even though rates of celiac disease in obese patients seems to be similar to that in the general population, the team recommends that patients with morbid obesity be tested for celiac disease in order to determine the best surgical strategy and outcome.

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8 Responses:

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said this on
04 Mar 2013 8:29:55 PM PDT
Very little real info here... celiacs can gain large amounts of weight due to inflammation. Constant hunger since they can't get nutrition from their food and overeating due to exhaustion and depression.

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said this on
11 Mar 2013 7:02:23 PM PDT
Yeah, I know I shrugged with my weight and I don't over eat a ton of food, but I was often hungry and eating also gave me some energy.

Now that I got some control, I still feel not so good, but at least it is not like death warmed over now.

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said this on
11 Mar 2013 1:32:45 PM PDT
When I was diagnosed with celiac disease, I was overweight. I would have never thought that it was causing my increased weight. I wasn't eating too many processed products either but wheat, regular oatmeal, etc. was in my diet. As soon as I went gluten-free, I lost the extra weight. I think this is good advice for obese patients because most would never think to have themselves tested. There is a stigma that people with celiac disease are super thin. Being overweight itself is a form of malnourishment. If changing to a gluten-free diet can help morbidly obese people with celiac disease lose weight, then this is a great alternative to surgery. I tried to lose weight for many years before my diagnosis with no luck. Being healthy was more important to me and still is, but the extra weight lost was a plus and helped my health as well.

Susan Copeland
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said this on
11 Mar 2013 9:11:36 PM PDT
My daughter was obese. We didn't know at the time that she shouldn't be eating gluten. She finally underwent gastric bypass surgery. The doctors told her after the surgery that they could see that her small intestines were inflamed, but they went ahead with the surgery. She then lost a lot of weight. After that, she developed oral cancer and died in 2008. I believe that if a local doctor had tested her and told her she shouldn't eat gluten ahead of the surgery she might have listened. They should test first by all means. It might have saved my daughter. I had her tested by Enterolab after the surgery, and the test was positive but her local doctor did a blood test and said she was fine with gluten. She believed the local doctor. I did not, but since my daughter was an adult there was nothing that I could do. I hope this story helps others.

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said this on
12 Mar 2013 12:58:13 AM PDT
I face a quandary here in that I was diagnosed with celiac disease after suffering severe diarrhea and a 10 pound weight loss in one week. All the proper testing proved the diagnosis, and I went on the gluten-free diet immediately. That was in 2004. Since then, I also suffer spinal stenosis, fibromyalgia, osteoarthritis, and a knee replacement in 2011. All of which have contributed to a 40 pound weight gain. I had recently lost 14 pounds, but have gained all back with a probable Hypothyroid problem rearing it's ugly head. And I hate it!!!! The medications to relieve the pain, including epidurals every 3 months, caused side effects including weight gain. So you add medications on top of a gluten-free diet which according to the foods one chooses to eat can be dense (sugars, natural grains to make bread,etc.,) and weight gain becomes a big problem. Going on the so-called "Cave Man Diet" does not guarantee weight loss especially when it is difficult to digest enough of vitamins, minerals, and other natural elements to help us to survive. Like the vitamin D3 deficiency that is common in those of us who have CD. It's a fine dance we dance just to live. My only hope is that the trials for the GF pill that shows really good success in helping to allow people to eat wheat, (I won't say cure, yet) will be released sooner than later. Maybe next year........ I would really like to remove CD from my bucket list!!!!!!!!


said this on
05 Sep 2013 8:06:43 PM PDT
I have always led a healthy lifestyle, but still suffered from many symptoms. I was diagnosed only 4 years ago. Little did I know that all that whole wheat was killing me. I have been on a strict gluten free and meat free diet and I still gain weight. I don't eat junk food, soda, or any gluten-free products such as breads, cookies, etc. I am also thinking of just doing the cave man diet, but I am probably close already. I don't know what to do. I will continue to research regarding weight gain and celiac disease.

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said this on
12 Mar 2013 7:04:33 AM PDT
I have Hashimoto's thyroid disease, and after experiencing symptoms of gluten intolerance, I went on a gluten-free diet. At the time, I was not seriously obese but about 30-40 pounds overweight. Since then, and this was nearly a year ago, I have lost not so much weight, but volume, especially in the thighs and waist area. As with Kristie, it was more important to me to be healthy and symptom-free than to lose weight. Apart from obese adults getting tested for celiac disease/gluten intolerance, maybe it would also be a good idea for overweight children.

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said this on
21 Nov 2014 8:33:54 AM PDT
I have always had a weight problem. In my thirties, after tipping the scale at 344 lbs, diabetic with high blood pressure and high cholesterol, I went through the roux-en-y gastric bypass. The first several weeks that I was only allowed liquids, the weight came tumbling off, eighty pounds. It was when the doctor gave the go ahead to eat solid foods that my weight loss came to a crashing halt. I was told that a half sandwich was acceptable for a meal as long as it was whole grain bread. Slowly, I watched with dismay as the weight loss not only stopped, but started creeping back on. The doctor was convinced I wasn't following the eating plan, even though I was. Ten years later, I'm still sixty lbs lighter than I was, but still feeling horrible. I was just tested for celiac three weeks ago. It's positive. I'll never forget going to a doctor several years ago and posing the question to her whether I could be celiac. She literally laughed at me and said, "No, that's not possible." I'd love to see her face now. I've been faithfully following a gluten free diet since, and so far, seven lbs have slipped off without a hitch. My advice: ANYONE who suspects they might have a problem with gluten, push your doctor to test you. I wish I had pushed sooner... I may never have had the surgery, and I probably wouldn't have the diabetes, arthritis, low thyroid, anemia, etc that I have developed over the years. Excellent article, and confirms my experience to a tee.

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Ditto. However, this is what I can never understand about gluten free food. (see the bold bits which I've taken from the article) "We wanted to determine if gluten consumption will affect health in people with no apparent medical reasons to avoid gluten. Gluten-free foods often have less dietary fiber and other micronutrients, making them less nutritious and they also tend to cost more,? I wonder why what so much of what I eat that's gluten free doesn't have added vitamins - we of all people need fortification in our cereals and bread, surely?

Yeah we learned that the hard way. I am inclined to think (as I did initially) that it was JUST the Cheerios but as time is passing and she is not bouncing back I am worried that we need to strip away dairy again for a while.

Oh I have no issue with being dairy free personally but tell that to a 13 year old. We both went gluten-free at the same time and it has been mindlessly easy for me. But I am easy about food and no real food issues. I am far more adaptable. She comes to the table with her own unique set of issues that complicate just easily transitioning to dairy free versions of much loved favorites. To most they are jst that "substitutes" to her they are completely different foods and ones that she has no interest in eating. They don't satisfy her need for XYZ. It is like craving an apple and someone handing you a fish. For her anyway! LOL!

I believe the talk around this forum is that cheerios are not gluten free enough for people with celiac at this time. I don't know if anything has changed on that and when their lawyer calls me I'll quickly delete this. haha

Could be we generally say get off of dairy for a few months when going gluten free. The part of the intestines that produce the enzymes, and help break down dairy are associated with the tips of the villi, which are the most damaged if not gone in celiacs. THIS is why most of us end up with a lactose intolerance early on. And most can introduce it later after healing. As to her symptoms with it there was a bunch of research about dairy permeated the gut and causing neurological issues in a autism study I was looking at years ago. And there have been other studies about damaged intestines and how the hormones in milk can easier effect ones body. Personally I also have a huge grudge against dairy on a personal level as it is not natural to suck on a cows tits and drink the stuff, nor your dogs, nor a rabbits......I mean come on even Human Breast milk you would find odd to drink as an adult right? Back in the past dairy was a great way to get calories and fats when there was famine, etc around I mean it is meant to make a calf grow into a 500+lb cow. But on a genetic and hormonal level it is not really for human consumption and now days the whole corporate BS propaganda push and dairy farms shove that oh its healthy stuff down your throat. There are plenty of dairy free options for everything feel free to message me if you need help finding anything I have been dairy free for over a decade.