Dr. Jeffrey Nathanson (NorthShore)

Excellent question, and one that comes up all the time.

If you had a reliable test for celiac (either a blood test or a biopsy of the small intestine at the time of an endoscopy), then you almost certainly don't have celiac. That's good news! You don't need to worry that if you ingest gluten (which by the way is in wheat, rye and barley) your immune system is going to react and that you could potentially develop some more serious issues, i.e. malabsorption of nutrients, or other autoimmune conditions.

However; a lot of people have a hard time digesting gluten. They may get bloating, or discomfort, or bowel changes, but that's it. Nothing worse. You can certainly try to avoid gluten to avoid these symptoms. However; if you do ingest gluten (either accidentally or on purpose because that piece of cake looked really good!), the worst that's going to occur is that you get some GI upset.

Dr. Jeffrey Nathanson (NorthShore)
Again, if we are talking about gluten intolerance (rather than celiac disease), there is no downside, other than you not being able to enjoy these foods. However; if avoiding gluten allows you to avoid the GI symptoms that have been so problematic, then it may very well be worth it.

Dr. Jeffrey Nathanson (NorthShore)
That's interesting. First, to clarify an important point, you don't have a food allergy. Food allergies are adverse reactions to foods due to the immune system reacting to it abnormally. Some food allergies can be very serious, even life-threatening (IgE-mediated food allergies). This is the classic example of someone with a peanut allergy who has trouble breathing with even minimal ingestion. What you have is a type of food intolerance. The fact that you are okay with eggs as an ingredient suggests to me that the eggs alone likely trigger some reflux in your stomach, which can then trigger the vomiting. When ingested with other ingredients though, the stomach response is muted and not an issue.

Dr. Jeffrey Nathanson (NorthShore)
Good question. Bloating is extremely common. The most common causes are constipation or excessive intake of gas forming foods (i.e. roughage in the diet). There are occasionally other causes which can be rarely serious. If they are any other "red flag" symptoms (i.e. weight loss, vomiting, fevers, significant pain), you should definitely see a doctor. Also, if you are above age 40 and this is new, you should discuss with your doctor. Otherwise, it would be reasonable to back down on the roughage in the diet (raw veggies, fruits with skins) and maybe take a gentle OTC laxative that is safe such as Miralax for a couple of weeks and see if symptoms resolve. If not, then yes, you should discuss with your doctor, but most of the time it is not serious.

Dr. Jeffrey Nathanson (NorthShore)
I often hear patients complain that protein shakes cause abdominal discomfort. Sometimes the protein load can be a little hard to digest. Plus often there may be other ingredients that can difficult to digest and can be gas forming due to their fermentability (i.e. green shakes). Also, if its made in a mixer, the air bubbles that you ingest can contribute to bloating discomfort. Furthermore, if you drink it through a straw, that's more air that you are swallowing that can also compound these symptoms. Keep it simple - try a different protein, minimize other ingredients, and don't drink thru a straw. See if that helps.

Dr. Jeffrey Nathanson (NorthShore)
If you do not have celiac, and you choose to avoid gluten, that does not increase your risk of celiac disease in the future. There is actually a genetic test that can assess your risk for celiac. The genes for celiac are carried by 1/3 of the population. If you get tested, and you do NOT have this gene, then you have zero risk of celiac now or in the future. If you happen to carry the gene, as 1/3 of the population does, most will never get celiac. But there is a small chance.

Dr. Jeffrey Nathanson (NorthShore)
Reflux is when stomach juices and/or gas come up from the stomach into the esophagus. Acid is the most caustic of stomach juices. Foods that increased acid reflux include spicy, greasy, chocolate, caffeine, alcohol, peppermint, and citrus. However, I hear people all the time complain that a particular food may cause reflux. Certainly avoiding that food is the first option. Chewing gum Even more important than particular foods, though, overeating and eating close to bed are BIG triggers. Smaller portions, staying upright after eating, not eating within 3 hours of bed, and keeping your head a bit elevated at night can all help.

Dr. Jeffrey Nathanson (NorthShore)
Are you intolerant to cow's milk too? There is a slight increased risk of soy allergy in patient's with allergy to cow's milk. I'm not aware any overlap with almond milk though. If you have intolerance to dairy, then there is the option of taking lactaid before dairy ingestion- a pill that contains lactase, the enzyme that patients with lactose intolerance are relatively deficient in. However, this is different from your issue.

Dr. Jeffrey Nathanson (NorthShore)
Lactose intolerance can be tested for with a breath test. However, sometimes there can be false positives. There's also a genetic test that picks up some, but not all, patients with deficiency of the lactase enzyme. Because both these tests have limitations, we often don't perform them. If the story fits - if you eat above a certain threshold of dairy, you get bloating, crampy, gas, and diarrhea - we say you have lactose intolerance. As for other food intolerances, with the exception nof a few other genetically defined deficiencies (such as G6PD deficiency), there are no tests.

Dr. Jeffrey Nathanson (NorthShore)
Carbohydrate intolerance - specifically short chain fermentable carbohydrates - contribute to a lot of GI symptoms, in particular in patients in whom we label as having "irritable bowel syndrome". These foods include wheat, rye, barley, onion, leek, garlic, artichokes, peas, legumes, dairy, apples, pears, cherries, peaches asparagus, honey, high fructose corn syrup, watermelon, mushrooms, and cauliflower. Studies have shown that the FODMAPs diet (acronym for Fermentable Oligosaccharides Disaccharides Monosaccharides And Polyols) can help some of these patients. But a warning: it is a very difficult to follow and, in my experience, often only provides partil relief of symptoms

Dr. Jeffrey Nathanson (NorthShore)
Food allergies affect approximately 5% of the population, involve the immune system, can be triggered by even tiny amounts of ingested food, and can cause serious, even life threatening reactions. These foods need to be strictly avoided and you need to be under the care of an allergies. Food intolerance affects 20% of the population, do not involve the immune system, and are due to difficulties in digesting and metabolizing food. The amount of food ingested is often directly related to the severity f the symptoms, and symptoms are often (although not always) limited to the GI tract.

Dr. Jeffrey Nathanson (NorthShore)
It may be a good idea for you to see a certified dietician to help you adjust. Generally speaking, you should avoid dairy. Often, individuals can eat small amounts and be ok(particularly of yogurt or hard cheese; creams and milk are generally more likely to trigger symptoms at a lower threshold. There is also the option of taking Lactaid which I mentioned early. It is a pill that contains the digestive enzyme lactase which you are deficient in.

Dr. Jeffrey Nathanson (NorthShore)
That is an interesting question. Celiac disease was first recognized after World War II. For years, it was thought to be a condition affecting only children and one really only thought about when children had severe issues of malnutrition and poor growth. More recently, it has been recognized that celiac can affect adults of any age too and that is manifestations are extremely varied. A significant number of patients with celiac don't have GI symptoms but rather other issues related to malabsorption such as osteoporosis or anemia. So doctors are thinking about it a lot more in a lot of different situations. In addition, our tests have become a lot better. The newest generation of celiac blood tests pick up >90% of celiac cases. Finally, and I think coincidentally, gluten free diet has become extremely popular. This has had the side benefit of increasing awareness of celiac, although sometimes has led to self-diagnosed celiac, which is an issue.