DEAR DR. ROACH: Iβm a woman in my early 40s. Several years ago, I began having messy bathroom-related accidents in my car after eating in restaurants. Doctors confirmed that I have an allergy to gluten, which made sense since one of my parents has it and I usually had just consumed wheat before having an episode in my driverβs seat.
Could I have induced this condition on my own with a previous addiction to everything from shredded-wheat cereal to sandwiches to beer, etc.?
Also, Iβve learned that one of the hardest parts about dealing with this allergy is the regular snide comments that Iβm βjust being trendy,β βpart of a fadβ and Iβll βget over it.β Iβm sure a lot of people are avoiding wheat by choice, but some of us have to do it out of necessity. Please tell your readers to be more gentle. β F.F.
ANSWER: I am pretty sure you are talking about celiac disease. Celiac disease is uncommonly (but increasingly) diagnosed: In the 1950s, it was estimated to occur in about 1 in 5,000 people. However, more-recent studies have estimated about 1 in 140 people, and the actual prevalence may be even higher, since there is variability in the symptoms of this condition. It is more common in those with a family history.
Celiac disease is more complicated than an allergy to gluten. Gluten, a protein in wheat and some other grains, can create a reaction in susceptible people in which the body causes damage to the lining of the intestines, reducing their ability to absorb key nutrients. In some people, like you, that leads to diarrhea and eventually to weight loss and sometimes severe nutritional deficiencies. Other people have more mild symptoms, such as abdominal pain and mood changes and may have iron deficiency.
You canβt blame yourself for causing this condition by consuming gluten. Wheat products are nearly ubiquitous in North America and Europe, and gluten triggers the reaction.
I have seen many people choosing to consume a gluten-free diet despite no (or almost no) symptoms. Some people feel better on this diet, but it is very hard to separate the effects of a major change in diet from a hopeful mind versus those caused by treating unrecognized celiac disease. Since lifelong adherence to this diet is called for in those with celiac disease, it is wise to be sure of the diagnosis. Importantly, the blood tests used to screen for the disease can become negative within weeks of being on a gluten-free diet, so the diagnosis must be made while on a diet containing gluten. Experts recommend a small bowel biopsy to confirm the diagnosis.
I cannot excuse snide or thoughtless comments about the difficult and socially awkward diet necessary to treat this potentially serious condition. I hope this column helps.
DEAR DR. ROACH: I am a male, 83 and take oxybutynin for a bladder issue. I read that oxybutynin can affect the brain. What do you think? β W.G.
ANSWER: Oxybutynin is one of the medicines on the Beers list of potentially inappropriate medications for the elderly (the whole list is at tinyurl.com/c5znrmc). It would not be my first choice for a man of 83, as confusion and constipation can be a problem. That doesn’t mean it should never be used, but both you and your doctor should be on the lookout for these side effects. You can ask your doctor if there are alternatives.
