DS and Celiac Disease

Hi All!  I am new here and am currently thinking about WLS.  I have Celiac Disease and PCOS.  Does anyone here have celiac??  Just wondering how it went after the ds??

Thanks!  I am learning so much by reading all your posts!

Hi and welcome! I don't have celiac, but I did remember a post from one of our most highly respected DS surgeons, Dr. John Husted, where he postulated that DS could actually cure celiac disease in some cases. I'll paste that paragraph here:

"Think on this:
The treatment for celiac disease is to eliminate gluten from the diet.
The part of the intestine where most celiac disease is found is in that part of the intestine that is bypassed in DS.
Since no food passes through this portion of intestine after DS, therefore, no gluten will pass by there either, regardless of how much gluten the patient actually eats.
Therefore, if patients have celiac disease limited to their duodenum and upstream intestine, BPD-DS, by diverting the flow of food/gluten away from the affected aea of intestine, is the surgical equivalent of being on a gluten-free diet, effectively treating celiac disease. "

WOW!!!!  How exciting this is!!  Thank you so much for postin this.   I can't wait to show my DH!!

Very NICE, Anna!  I was just thinking about that thread, where POOF, you have it already pasted.  Well done, my dear!

Please notice that the 1st responder said that Dr. Husted postulated that the DS "cures" Celiac Disease.  I seriously doubt that you would find any reputable gastroenterologist anywhere in the country who currently shares that opinion.  As a matter of fact, I have a feeling that most, if not all, of those GI docs would recommend that you not undergo ANY malabsorptive procedure if you have a positive diagnosis of Celiac Disease. 

CD is already a disease of malabsorption, and it is easily treated with a gluten-free diet in most cases.  All of the other health conditions which are associated with CD can be directly attributed to the malabsorption which is caused by the gluten reaction.  If you look at some of the folks who are just a few months to a few years out from malabsorptive WLS, there are quite a few who are having one or more of the same health problems that are seen in people with undiagnosed Celiac Disease. 

That cannot be a coincidence - in both cases I daresay that malabsorption is responsible for these problems.  If you are determined to have WLS, then you need to first consult your GI doctor, then look into one of the WLS procedures which only involves restriction.

How long ago were you diagnosed with CD?  I was diagnosed last year, and I have managed to lose almost 40 pounds, simply by following a gluten-free diet.  If it hasn't been very long since your diagnosis, you might want to give the GFD a little while longer to work.  It certainly should help your PCOS!

If you are familiar with www.celiac.com, I have seen a couple of questions on their forum regarding WLS - all of the posters felt that it was not a good idea for someone with a CD diagnosis.  Just go to the "Weight-Related" section of their forum and ask any question that you may have regarding WLS.

I'm not trying to discourage you, but if you have CD, then you REALLY have to think long and hard before deciding to have WLS.  I don't know how many years you went before your CD diagnosis, but if you are like most people, it was several painful years.  Remember how that felt, and ask yourself if you are willing to feel like that again - because most of your pain was most likely caused by complications due to malabsorption / malnutrition.  If you decide to have either the RNY or the DS, you will probably feel that way again at some point in the future.

Sorry to be such a wet blanket - I am not going to tell anyone not to have WLS, but I personally think that it is a potentially devastating choice for someone who has Celiac Disease (and chances are that the folks who have the most catastrophic complications after WLS are the ones who have an undiagnosed case of CD).

Teresa Koch
Fort Worth, Texas

Note: Edited to correct grammar.......

Please notice that Teresa is NOT a well respected & published bariatric surgeon, nor does she have any medical credentials, nor has she herself even had WLS.

While she has been a great resource to those who, pre -or- post WLS find they have a sensitivity to gluten (note: not been diagnosed with Celiac Disease), she is very anti-WLS and inserts herself as an expert in an area that is still has a long way to go in understanding the disease.  She has been called out on her *facts* many times, and I've read enough to know that she is is passionate and knowledgeable about her own situation (her own & family members), but she is by no means an expert on the very complicated disease with all its variables.

So, if you need to hear first hand experience on how someone tackles their (undiagnosed by standard testing) Celiacs Disease, she would be a great resource.  If you need to hear how someone tackles the diagnosed Celiacs of her daughter, she would be a great resource.  If you need to know how you personally would respond to the DS with your version of Celiacs (I say version, because I believe that as research progresses, we will find that Celiacs is as complex as cancer, autism, etc... it won't be simple), then you should consult with a very highly respected DS surgeon who has studied this complex disease  (Husted is obviously one).  Also, you are the expert in your Celiacs, so study the DS anatomy and connect the dots on what this will mean to how your Celiacs manifests itself.

But, please, don't discount WLS, if this is something you need for health reasons simply because Teresa has found the  *magic bullet*  to losing weight without WLS  (her results are not impressive from a weight loss perspective, IMO, and certainly wouldn't have addressed the co-morbs that lead me to WLS).  Address this complicated situation with a medical professional that knows  *both*  Celiacs & the DS -- they will be few & far between, but it is your responsibility to find those experts.

Kimberly,
Yes, it is true that I am not a well-respected and published bariatric surgeon, nor do I have any medical credentials.  I daresay that the same can be said about most people who post on these boards.

I AM NOT anti-WLS, and if you have read my posts, you will find that to be true.  I just feel that it is important to caution people who may have an undiagnosed (or diagnosed) case of CD to be VERY THOROUGH when they are researching WLS.  But I think that you would agree that EVERYONE should do their research when it comes to WLS - I read over and over that it is not "the easy way out", and there is a lot of stuff that has to be addressed AFTER the surgery in order to maintain optimum health.

I do stand by my "facts" - if anyone has a problem with what I tell people, they are more than welcome to go to any Celiac website to confirm them.  No, I am not an expert on this complicated disease, but I don't think that any layperson can claim to be an expert on WLS, either.  In both cases (CD and WLS), there is a lot of research still to be done.  In my case with CD, and the case of many who post on these forums about WLS, we have ALL done personal research to find out as much as we possibly can about something that directly affects our lives.

My Celiac diagnosis HAS been confirmed by my doctor, due to my skin rash, my positive response to a GF diet, and the presence of one of the genes that is associated with Celiac Disease (got that test result back a couple of months ago) - many people are diagnosed this way, especially those who have the skin rash (Dermatitis Herpetiformis), as many times they DO NOT test positive for the antibodies associated with CD.

Please, please, please DO NOT counsel someone with CD to consult with a DS surgeon who is familiar with CD without telling them that their GI doctor should be the "last word" when it comes to their intestinal health.  Unless a WLS surgeon has extensively studied CD, they, too, cannot have a complete understanding of the complexities of this disease.  I agree, when it comes to DS surgeons who are knowledgeable on CD, Dr. Husted knows more than anyone else - he and I have traded e-mails, as a matter of fact. 

I am sorry that you feel that my weight loss results are not impressive for someone who hasn't had WLS; I am rather happy with my results, and in the end, that is all that matters.  The fact that I have been able to do this without feeling like I am on a diet, and the fact that for the first time in my life I have been able to keep the weight off is a personal victory for me.  I do not doubt that I will continue to lose weight on a GF diet (and I do have to stay on it for the rest of my life) - it may be slow, and I have found that every time I accidentally get gluten in my system I gain 5 pounds overnight, and it takes 1-2 weeks to get the gluten (and the weight) out of my body. 

I wholeheartedly concur with you that the OP needs to address this situation with a medical professional - but it needs to be someone who is FIRST knowledgeable about Celiac Disease, and I stand by what I said in my original post; I doubt that any GI who knows anything about CD would advise their patient to have a malabsorptive form of WLS.  I could be wrong about this, but I have a feeling that I'm not.  That would still leave the Lap-Band and the VSG available for the OP, however. 

I know that you are a very knowledgeable person yourself, and I appreciate your comments.  Please don't take anything that I have said in the wrong way; I certainly didn't mean it to come across that way -

Teresa K.
Fort Worth, Texas

Hello Teresa, I just wanted to comment to a few of the comments/replies you've made. 

Please notice that the 1st responder said that Dr. Husted postulated that the DS "cures" Celiac Disease.   I seriously doubt that you would find any reputable gastroenterologist anywhere in the country who currently shares that opinion.

Regarding this comment, Dr Husted is one of the top notch bariatric surgeons in the world and has written many articles and research studies. He does have real life patients who have Celiac Disease and are post-op DSer. If he states the DS "cures" Celiac Disease, it is based on his medical reports and finding of post-ops patients and other research. He has performed 100s and 100s of DS surgeries. This is very important for you to note, he has patients who have Celiac Disease prior to having the DS and now are "cure" of the condition and making it very clear the contribution of the DS and those who had Celiac Disease based on also his research of live testimonial DSer. Also, I am sure Dr. Husted consult with his medical peers in regards to the DS and celiac disease.


I seriously doubt that you would find any reputable gastroenterologist anywhere in the country who currently shares that opinion.

I know you limit yourself to www.celiac.com website and use that as your only reference point.  In NYC, there is a The Celiac Disease Center located at New York Presbyterian Hospital - Columbia Unversity Medical Center. It is operated by recognized medical experts who are gastroenterologist that specializes and is dedicated to the treatment and study of Celiac Diseases, as well do research, provide education to patient, medical physicians and the general public. It is headed by Dr. Peter Green and if you are into knowing about Celiac Disease, then you should know who he is and you will also know that The Celiac Disease Center at New York Presbyterian Hospital - Columbia University  Medical Center is the ONLY center in the US that provides comprehensive medical care, including nutrition, for adult and pediatric patients with Celiac Disease. You should also know that the Celiac Center does all its research that is directed toward Celiac Disease that includes clinical epidemiology, the mechanisms of celiac disease and education. I am sure you are aware that patients from AROUND THE WORLD go here to be diagnosed and treat for Celiac Disease.
 
You've made the comment that "seriously doubt that you would find any reputable gastroenterologist anywhere in the country who currently shares that opinion".

I have to say, if you are not associated or have connections to communicate with reputable gastroentologist or Celiac Disease specialties and their treatments, don't make Mickey Mouse statements.
 
Dr. Suzanne Lewis was my gastroenterologist since 1999 and PCP. She was also my PCP after I had my duodenal switch for another 2 years. She is a world class celiac disease specialist and shares Dr. Husted opinion that the DS does "cure" Celiac disease because of the way the intestinal bypass is configured and that the part of the intestine where most celiac disease is found is in that part of the intestine that is BYPASSED in the DS and since no food passes through this portion of intestine after DS, therefore, no gluten will pass by there either, regardless of how much gluten the patient actually eats. I have high respect for her as she treated me for 8 years- 6 years as a pre-op with severe Inflammatory Bowel Disease and as a Duodenal Switch post-op patient with malabsorption.

She was also the gastroenterologist whom RECOMMENDED I have the DS and wrote my referral to have it done. To describe who she is, Dr Suzanne Lewis has been a gastroeneterologist for 24 years and is an Associate Professor at The College of Physican and Surgeons, Columbia University and is a world medical specialist on celiac diseases, especially refractory. She is an attending gastroenterologist medical physician and world class specialist in Celiac Disease. I believe her word based on her medical experience and research than your comment that NO REPUTABLE GASTROENTEROLOGIST shares the opinion that the DS "cures" celiac disease. She also has many published research and studies regarding celiac diseases. She is pro-WLS and pro-DS because morbid obesity is also a medical disease that does KILL you.

Suzanne K. Lewis, MD Associate Professor of Clinical Medicine, College of Physicians and Surgeons, Columbia University Dr. Lewis received her medical degree at the Albert Einstein College of Medicine. She did her training in internal medicine and fellowship in gastroenterology at Columbia Presbyterian Medical Center.

Dr. Lewis has been an attending Gastroenterologist at New York Presbyterian Hospital since 1990 participating in teaching medical students and house staff, as well as having a private practice in gastroenterology. She has served as director of the Endoscopy suite at the Allen Pavilion. Dr. Lewis is a member of the American Gastroenterological Society, the New York Society for Gastrointestinal Endoscopy, and the American College of Physicians. She has done research in adenomas in inflammatory Bowel disease. Her interests include celiac disease, inflammatory bowel disease, malabsorption, and endoscopy.

I doubt that any GI who knows anything about CD would advise their patient to have a malabsorptive form of WLS.  I could be wrong about this, but I have a feeling that I'm not.

Regarding that statement above, a GI who know anything about CD and morbid obesity would be advise/recommend their patient to have a malabsorptive form of WLS that is known as the DS because of its intestinal bypass mechanism in relation to celiac disease because the part of the intestine where celiac disease is found is in that part of the intestine that is the duodenum and its distal duodenum and jejunum is BYPASSED in DS. Due to this, no food passes through this portion of intestine and no gluten will pass by there either, regardless of how much gluten the patient actually eats. For Celiac Disease the area biopsied is from the duodenum and as DSers this is bypass to be part of the digestive juice limb and where no food is touches.

Dear PrettyDove,
Thank you for your information - Dr. Husted (and now Dr. Lewis) is the only Dr. that I have heard of *****commends the DS concurrent with a CD diagnosis.  However, I do not think there is ANY medical research that conclusively proves that the DS cures CD.  When our daughter was diagnosed, we were told that there is no cure for CD - and we have seen that over and over again in literature.

Yes, I know of Dr. Green, and to think that someone who has a Celiac diagnosis ONLY uses www.celiac.com as their informational source is like saying that someone who is considering WLS ONLY uses www.obesityhelp.com as their information source.  The only reason that I refer people to that site is that it is a comprehensive "jumping-off" point that is very user-friendly - it will get the person who is looking for information where they "need to go".

Believe me, Dr. Green's book was the FIRST thing that I bought after Rebecca's diagnosis - I still refer back to it quite often.  I also visit not only his website, but that of Dr. Alessio Fasano, who is another leading researcher in this country.  I have corresponded with Dr. Fasano on other matters pertaining to Celiac Disease (mostly regarding issues with Down syndrome, for obvious reasons).  I go to www.celiac.org, www.gluten.net, and I am on several different chat groups and e-mail lists and I am getting information all of the time.

As far as Dr. Green's Celiac Disease Center being the ONLY one that provides comprehensive Celiac Information, I have a feeling that the folks at the different Celiac Disease research centers around the country - The University of Chicago Celiac Disease Center, The University of Maryland Center for Celiac Research, William K. Warren in San Diego, The Mayo Clinic, and The Celiac Center at Beth Israel Deaconess at Harvard University, not to mention the Stanford Celiac Sprue Clinic and the Rush University Clinic - would be very surprised to hear that they don't exist.  Dr. Green's is perhaps the best KNOWN research center, but even he would tell you that his is by no means the only Celiac Research center in the country.

As I said, I had never heard of a GI who endorses the DS, and so far, the only one that I am aware of is the one that you brought to my attention (Dr. Lewis).  I will be sure and save this information - thank you for sharing it with me.

Teresa K.

Thanks Teresa that is good to know there are now other places available for comprehensive care, treatment and education. What's the difference compared to others in what they provide, I do not know.

Aside from Celia Disease, my main focus for almost 2 years, has been on Phytic Acid that is found in bran portions of all grains (wheat, oat, barley, corn, soy, soybean, kidney beans, rye, bran, legumes, certain breakfast cereal and even tofu). These have a contributing factor to block and prevent the absorption of calcium, magnesium, copper, iron and zinc to cause greater mineral deficiencies. No matter what, phytic acid will not allow us absorb these. Calcium and iron is a greater concern for anyone with malabsorptive issues and making sure these levels and trends stay within the normal range. I have avoided eating these type of food when I take my supplements because I know they deplete my nutrients if eating food with such within the same time frame.

This phytic acid issue is not limited to malabsorptive procedures such as RnY and DS, but also restrictive surgeries such as Lapband and VSG, as well as, those that do not even have any WLS, such as you and any other person out there.

In addition, this anti-nutrient can lead to bone loss that does leads to osteoporosis and just knowing it creates calcium deficiencies that is vital to many of us here, especially women (and iron deficiency too, since it prevent absorption of it). I just keep to eating breakfast cereal as a snack and away from my calcium, copper and zinc supplements and hours away from my iron supplements, hence why I take iron at bedtime. 

Long term consumption of these untreated phytates may also be a contributing factor to bowel movement conditions, as well as taking calcium and eating food with phytic acid that can cause diarrhea (and if celiac disease was ruled out, then this is one that needs to be investigated calcium to phytic acid consumption). I just make sure I do not have any of these type of food with my supplements during any of my meal time and it is difficult at times to work around and the timing from it. I have not eliminated these grains per se, but work around it to eat it at times that I want to and careful as I said in timing with my supplements. An excellent book to read about this and other stuff  is Food & Nutrition Encyclopedia, 2nd Edition by Audrey Ensminger. I wouldn't recommend to buy the book since it cost $400, but maybe you can read some of the chapters at a major library.

Celiac Disease deals more with gluten that is certain grains such as rye, wheat and barley. Phytic Acid deal with grains, cereal and legumes. Soybean and soy is one that has to be eaten away from your calcium, iron, zinc, magnesium and even copper supplements. I thought soy and soybean was an excellent choice, until I found out it is high in phytic acid.  As a DSer who does not have Celiac Disease, just knowing how certain grains affect our health and system is enough to make awareness in what we eat and how it affects our nutrient absorption. Phytic Acid is a very wicked anti-nutrient and is a contributing factor to cause depletion and deficiencies, especially when taken with daily supplements during meals. You should also look into Phytic Acid because it does prevent certain minerals absorption that we need to provide for good health and bloodwork.