A nurse practitioner asked for advice regarding a workup on a 34-year-old white female with complaints of chronic fatigue, “brain fog,” bloating, and constipation. The patient denied fever, chills, and similar symptoms. Thyroid, glucose, and anemia tests were negative. The patient was on no medications and said she sleeps well despite working long hours.

The patient’s lab work was positive for very low vitamin D. Although the celiac panel was negative, we suggested a 2-week trial of a gluten-free diet. The patient, who declined a GI consult, followed the diet, and experienced a near-total resolution of symptoms even before the end of the first week. 

Although gluten intolerance used to be considered nearly diagnostic of celiac disease, researchers now believe that non-celiac gluten sensitivity (NCGS) may be even more common. Not the same as a wheat allergy, gluten sensitivity is thought to be a more complex inflammatory response to one or more of the protein complexes in wheat gluten. Studies are ongoing as to the exact cause of this condition, but a simple elimination-diet challenge was sufficient to answer this patient’s problem. She was also supplemented with daily vitamin D3. (195-1)

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Sherril Sego, FNP-C, DNP, is a primary-care nurse practitioner at the Department of Veterans Affairs Medical Center in Kansas City, Mo.

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