Possible symptoms from cereal vary

By Allen Douma, M.D.
Tribune Media Services

Q. This may not sound like much, but every time I eat cereal it seems like I get loose bowels and stomach pain. I can really notice it because I’m normally constipated. A guy I know has something called celiac sprue, and he says when he eats cereals he has the same problem. I don’t mind the change so much, but I would like to know how I can tell if I have celiac sprue. — C.A., Tucson, Ariz.

A. Celiac sprue is a condition in which someone is unable to digest gluten. This is a protein found in certain grains such as wheat, rye, barley and oats, but not in rice or corn. Since most cereals are wheat- or oat-based, it should be considered in your case.

Celiac sprue is inherited, but symptoms usually don’t appear until after the age of 20. Celiac sprue is characterized by widespread damage to the walls of the small intestine. And the passing of undigested food into the large intestine results in bloating, flatulence and diarrhea. This may lead to symptoms of nutritional deficiency and weight loss.

Blood tests for antibodies to gluten are a good screening tool for celiac sprue. Analysis of tissue biopsied from the wall of the small intestine is the standard method for diagnosis of those with positive antibody results.

Treatment is straightforward — remove all sources of gluten from your diet. Of course, this means all wheat, rye and barley. Most health professionals also recommend eliminating oats in the diet, but a recently published study showed that eating moderate amounts was not harmful.

But products containing gluten as a food additive, such as prepared soups, sauces, ice creams and hot dogs, are widespread, so you must be very vigilant to eliminate them from the diet.

You should see dramatic improvement in a few weeks after starting the gluten-free diet. If properly diagnosed and treated, most people with celiac sprue have excellent chances for recovery. Only rarely does the situation become severe and life-threatening.

Because you don’t indicate problems with other foods, I suggest you consider another possibility — lactose intolerance. It gets its name from the main sugar found in all dairy products, including milk. To digest lactose, an enzyme (lactase) is required to break lactose apart. When too little lactase is present, excess lactose ferments, causing bloating and diarrhea.

All babies have a high amount of lactase, so they can digest milk very well. But a large percentage of Native Americans, African Americans, Asians and people of Jewish decent will have much lower levels of lactase as they get older. People who develop lactose intolerance almost always do so by the time they reach adulthood, but it’s possible to happen later.

Following intestinal infections, many babies have a decreased ability to digest lactose. So it’s often wise to decrease or eliminate dairy products from babies for a few days following such infections.

Some people have a very limited intake of dairy products. You may be one of them, so you are only exposed to significant amounts of lactose when you eat cereal with milk.

To determine if you have this problem, stop using all dairy products for a few days. Then try drinking milk without the cereal and monitor the results. The problem would recur with any dairy product, including yogurt and butter.

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