ArcaMax

DEAR DR. ROACH: I am a reasonably healthy 81-year-old retired man, although I wear a pacemaker and have bad arthritis. My daughter insists that I'd be much healthier and happier if I eliminated gluten from my diet. I don't even know what gluten is or which foods it's in. So, am I flying blind into a storm about all this? -- Prof. G

ANSWER: Gluten is a protein found in cereal grains, specifically wheat (which has many types and names such as durham, semolina, spelt, farro and einkorn), rye, barley, triticale and sometimes oats. (Oats have no gluten but are often contaminated by being grown, processed or transported with a gluten-containing grain.)

Gluten contains a protein called gliadin, which causes some people to develop an immune reaction. It isn't an allergy, but in people who are predisposed to this reaction, gluten can cause damage to the lining of the intestine and a wide variety of symptoms. Celiac disease is when a person has changes in the lining of the small bowel while consuming gluten, which then go away when a person is on a strict gluten-free diet.

Classical symptoms of celiac disease include abdominal pain, diarrhea, weight loss, distention and bloating. Some people have very mild symptoms, while others are very intense. When the damage to the intestine is severe, a person cannot absorb many nutrients well and can develop iron-deficiency anemia, folic acid or B12 deficiency with their attendant hematological and neurological symptoms, a specific skin disease (called dermatitis herpetiformis), metabolic bone disease and osteoporosis, and others. (Arthritis is not associated with celiac disease.)

In people with vague symptoms or those who don't have a family history of celiac disease or other risk conditions, a simple blood test is adequate to make sure that the person doesn't have celiac disease. In people who are at a low risk with nonspecific or no symptoms as well as a negative blood test, then celiac disease is excluded, and a gluten-free diet is unnecessary.

I have had patients go on a gluten-free diet and feel better without having had diagnostic testing for celiac. It's possible that they had undiagnosed celiac disease, but a huge change in the diet can trigger a placebo response. Since the blood test can turn negative on a gluten-free diet, the antibody test should be done when a person is consuming gluten.

People with a nonceliac gluten sensitivity (NCGS) do not have celiac disease but do develop symptoms such as bloating or abdominal pain after eating gluten-containing foods. Experts think most people with this syndrome have symptoms very much like irritable bowel syndrome that are triggered by components in the food called FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols). Gluten is not a FODMAP, but wheat contains fructans, which is a type of oligosaccharide.

For people without celiac disease or NCGS, changing your diet is not necessary and may not make you healthier or happier. Gluten is a healthy part of many diets.

DEAR DR. ROACH: Is ichthammol effective for cysts and boils? -- V.P.

ANSWER: Ichthammol, also called ichthyol or ammonium bitumenosulfate, is a drawing salve that has been used for more than a century to treat boils, psoriasis and eczema. Its usefulness in cysts is not as well-documented. It's not a medicine that I prescribe as there are many other well-studied available options, but dermatologists occasionally use it.

It must not be confused with a corrosive salve, sometimes called black salve, which is an ineffective and dangerous substance that is sometimes promoted for the treatment of cancers. It should not be used at all -- ever.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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