I have a patient with strictures in the colon, so she has intestinal blockages. Her M.D. wants her to have a balloon endoscopy. Prior endoscopy showed mildly positive for celiac. Isn’t that like being mildly pregnant? Has to take MiraLax once a day, but still a normal stool only happens once every four to seven days, which a lot of doctors won’t even call constipation. She eats mostly clean for gluten because she has anaphylaxis-type reactions if she eats too much. She can do yogurt and probiotics but can’t do sauerkraut because anything with too much fiber really slows her down. She does well on a low-residue, small-portion diet. How to do Doctor’s Data three sample if she’s only going once a week? Any other suggestions besides getting her to totally avoid gluten, etc.?

Chris Kresser:  I mean that, of course, would be my suggestion and giving her as much literature as you can to understand. I think I wrote an article where I talked about the consequences of silent celiac, which is the form that is “mild” that can have—where I list a lot of statistics about how much your risk of morbidity and mortality goes up if you have that, it’s not treated, and you continue to eat gluten. I don’t know if this patient would respond to scare tactics or not, but that is certainly something you could do. For a stool test, I wouldn’t do the three sample. I would just start with one and see what happens there. I would definitely do a SIBO breath test. It wouldn’t be surprising to see that she has methane-predominant SIBO. I would use some of the interventions that we talked about for constipation because constipation is both a symptom and a cause. It’s usually a symptom of a deeper problem, but it can become a cause of a problem too. If there is a backup of stool in the gut, and the body is not eliminating properly, then that can definitely be problematic.