Published June 02, 2022
Anyone dealing with gut issues knows how frustrating and uncomfortable it can be. Common problems include a range of symptoms from reflux and heartburn to abdominal pain, diarrhea, constipation and bloating. Quick fixes, supplements and certain diet changes may not help. Jill Gaidos, MD, Gastroenterologist, Associate Professor of Medicine in the section of Digestive Diseases and the Director of Clinical Research for the Yale Inflammatory Bowel Diseases Program, answered some common questions about digestive health and when to seek care.
No, not everyone needs to avoid gluten. Gluten is a protein found in foods that contain wheat, rye and barley, which are very common in a Western diet. Unless you are allergic to it or it causes you to have adverse side effects, such as bloating, rashes, or diarrhea, then there is really no reason to avoid it.
Gluten intolerance may be less common than you think. In a review in the World Journal of Gastroenterology in 2017, the prevalence of non-celiac gluten sensitivity was estimated to affect up to 6% of the U.S. population. Only 1% of the U.S. population has a diagnosis of celiac disease, which is an allergy to gluten. Symptoms of celiac disease can be variable but include fatigue, loss of appetite, weight loss and diarrhea. Testing for celiac disease is a 2-step process. First, a blood test can be used to check for antibodies to gluten. If the antibodies are found, the second stop is to perform an upper endoscopy to obtain biopsies of the duodenum, which is the first part of the small intestine, to confirm the diagnosis.
No, not everyone should avoid dairy products. There is already a very high prevalence of vitamin D deficiency in the U. S. population and the main dietary source of vitamin D is dairy products. Vitamin D not only plays an important role in bone health but is also a key factor in the immune system. So, unless dairy causes you to have uncomfortable symptoms, then there is no reason to avoid it.
There was a recent guideline created by the American Gastroenterological Association on the use of probiotics in GI illness. In that guideline, the only time probiotics were recommended in adults was for those who were taking antibiotics and for those with pouchitis, which is inflammation that can occur after surgical resection of the colon. For other diseases or digestive health symptoms, we do not have any evidence that probiotics are effective. We don’t have any evidence that probiotics are harmful either. I do have patients with various symptoms who have felt better after starting on probiotics. In those cases, it is safe to continue the probiotic.
The idea of a leaky gut is that the cells lining the intestines are not tightly adhered together and that particles in the intestinal stream – like bacteria or viruses – could translocate or migrate into the intestinal walls where they should not be. But, we don’t have good tests for leaky gut so the overall prevalence is unknown.
This really depends on what specific symptom you are having. There are different criteria or red flags for when to see a doctor for someone with reflux compared to someone with abdominal pain. But, if you are experiencing abdominal pain, problems swallowing, bloody stool, heartburn or changes in bowel movements that persist, talk to your primary care doctor about whether you need to seek help from a gastroenterologist. Primary care doctors are trained to treat some of the minor GI symptoms patients may experience and will also know when you need to see a gastroenterologist who is trained to screen, diagnose and treat digestive disorders.
