Pediatric Center of Round Rock

It seems that everyone from parents to big companies such as Quaker are paying attention to gluten these days. With people swearing by a gluten free lifestyle for their family, it leaves some parents with questions. Should I eliminate wheat from my family’s diet? How do I know if a family member is sensitive to gluten?

Dr. Katalenas sat down with Dr. Murali Jatla, a Pediatric Gastroenterologist to answer all of your questions.

Dr. Katalenas: What is the difference between Celiac disease and gluten sensitivity?

Dr. Murali Jatla: When we do a biopsy of someone with Celiac disease, we will find inflammation of the small intestine and abnormal antibodies. The person must have the genes to go along with it and the intestine must be inflamed. In a person with gluten sensitivity, gluten may upset the stomach but there will be no inflammation. In patients with gluten sensitivity, they might find relief from their symptoms by eliminating gluten from their diet.

Dr. Katalenas: Is this a new disease or something that has surfaced in the last 10 years and we have been missing it all this time?

Dr. Murali Jatla: That is hard to know. We have reports of people diagnosed with Irritable Bowel Syndrome or spastic colon  but actually Celiac disease was the source of the problem. They felt better when they eliminated gluten from their diet. There are definitely more options available gluten-free which is healthier because it forces people to eat more fruits and vegetables.

Dr. Katalenas: If someone is diagnosed with Irritable Bowel Syndrome, does it make sense to eliminate gluten from their diet to see if they feel better?

Dr. Murali Jatla: I would recommend doing blood tests first and screening for Celiac disease. If we eliminate gluten from the diet before the tests are done, we might not find the Celiac disease. We then would have to instruct the patient to put gluten back in their diet for four weeks, which would make the patient miserable.

Dr. Katalenas: What is the diagnostic process like for Celiac disease?

Dr. Murali Jatla: I lean heavily on blood tests. If there is any question, I will do the gene test and the endoscopy. Most of the time, the blood test is all that is needed. For example,there is no test that proves Irritable Bowel Syndrome, so we look for the symptoms of Irritable Bowel and the things we do know how to diagnose. If we have ruled out all other possibilities, then we can say it is Irritable Bowel.

Dr. Katalenas: Are we eating too many carbohydrates in our diet?

Dr. Murali Jatla: I imagine that we eat a reasonable amount of carbs.  I think one place where there is an over indulgence is soda and fructose and those types of simple sugars.  As far as complex carbs, we are doing a fair job of eating a reasonable amount.

Dr. Katalenas: I see the additives in juice drinks and the high fructose corn syrup that is added everywhere. Children eat and drink a large amount of these carbs.  Do you think this has anything to do with all of the stomach and intestinal issues we see in our children today?

Dr. Murali Jatla:  I think sometimes we forget that too much of a good thing is not a good thing.  We also take things for granted. Some things that were invented, such as sports drinks, were invented for people that expend a lot of energy and a lot of kids that are drinking them are not expending a lot of energy. They use them as their primary beverage.  So whenever possible  I encourage that children drink water as the primary beverage even if we have to flavor it with a sugary flavoring.

Dr. Katalenas: Often I talk to families who say all their stomach issues have gone away with a gluten-free diet and ask if they should eliminate gluten in their children’s diet. Is gluten the cause of all intestinal problems today and are probiotics the cure all?

Dr. Murali Jatla: I have an idea that gluten is just one of the culprits.   Again, I think there is nothing beneficial about gluten in your diet.  It is just hard to separate it from the food it is in.  I think it is important that everyone knows  before embarking on a gluten-free diet that it is not to be taken lightly. It is a serious decision and the primary care doctor should screen for Celiac disease before removing gluten from their diet.

Regarding probiotics, I think, again, we are eating less foods where we would normally get these things, like breast milk, yogurt and things like that.  We need to incorporate those back into our diet. I think there are ways to get back to the basics without having to go out of our way to avoid things in our diet or to supplement with probiotics. I think probiotics are low risk but it requires time, effort and money and no one should take anything they don’t need.  We need it in our diet but I don’t think we should supplement.  I also don’t think gluten is the source of all intestinal problems and probiotics is not a cure all.

Dr. Katalenas: Can you tell us what probiotics are and what is in them?

Dr. MJ:  The most common probiotic people think of, “lactobacillus”  are in the active cultures that are found in yogurts and buttermilk and are starting to be fermented.  There are other probiotics “acidophilus”, “florastor” and “bifidobacterium”. We think they are all sort of equivalent and are the good bacterias that we normally get in our diet, but we might be low if we don’t eat the right type of foods or if you have been on antibiotics lately. Probiotics come in tablet and powder form and are megadoses of billions and billions of these bacterias in each of these capsules.  I think all brands are equivalent and can be found in grocery stores or drug stores or whatever is on sale.

Dr. Katalenas:  Where can patients go for help and where do you see patients?

Dr. MJ:  I see patients as part of the McLane Jones Hospital of Scott and White in Bethel, Waco, Round Rock, and I partner with seeing patients in San Marcos, Killeen and College Station Texas.  Our website is www.swchildren.org.

I think some of these issues are very complicated and it’s important to find a General Provider that feels comfortable consulting about these issues and takes the time to explain the symptoms; because for a patient and parent it can be very confusing.There is a lot of advertising that is not clear and of course the doctor should be comfortable discussing the difference.  Sometimes the symptoms appear subtle but there are really big differences between Celiac disease and gluten sensitivity, so you need to find someone to help you navigate down that path.

Dr K: Some patients tell me that doctors act a little skeptical when dealing with digestive problems and that we are telling them it is all in their heads and acting as if they don’t really have a disease.  How do you feel about this?

Dr. MJ:   As a pediatric gastroenterologist I am very sympathetic when someone says “I don’t know how to explain that when I take these I feel better”.  If that is the case,  whether I agree or not, or support it or not, I feel it is dangerous and we need to make up any deficiencies by thinking of ways to get around that.

I am not in people’s kitchens to say you can’t do certain things. We have a dietitian that works closely with us and there are many times we try a gluten free diet or try something else if we are not one hundred percent sure or have some clue it will work.  So again I think the key is not to make your life anymore restricted than it needs to be, and to know when to stop doing something, and when to say we did that long enough. I think if someone has guidance to try something for two days, two weeks or two months, and it doesn’t help we need to move on and try something else.

As in Irritable Bowel Syndrome there is  definitely an emotional component associated with this. There is no doubt that there is a mind and gut connection and it is much stronger in the gastrointestinal area than in other conditions.  So we try to be supportive and sympathetic and sometimes it is hard to prove some of these things.  At the end of the day, our job is to give information and a lot of these conditions don’t have specific answers.  A lot of it is trial and error, and some of it is what the patient feels, and we perform the tests we have at our disposal, but they don’t always answer all of of the questions.

About the Author

Dr. Katalenas

Dr. Katalenas is a pediatrician and owner of The Pediatric Center of Round Rock and the author of the book "The Step Up Diet: From Scratch… The Quality, Quantity, and Timing Solution to Childhood Obesity", a guide to healthy cooking and eating for busy families.