I have had increasing success with my patients who have chronic abdominal discomfort. We certainly have to think about the usual suspects such as gastritis, constipation, lactose-intolerance and food allergies that can be confirmed through allergy testing (and rarely crohns). However, I am seeing increasing failures in correct diagnosis and treatment of these conditions. I’ve started trying more and more of these patients off of the genetically modified wheat that is found in everything. Actually, it is not found in everything, I exaggerate. But it is found in more than you would think. I use Dr. Davis’ “Wheat Belly Quick and Dirty” post from his blog to help the patient identify which foods to avoid, the devil is in the details. I hand the patient a copy of this. They generally have been through other tests and treatment methods that have failed and are eager to try it. I recommend a one month trial and a follow up visit with me. The results are wonderful. Particularly with my teenage patients from whom I get a much more accurate history. Once they experience life without daily abdominal discomfort they don’t want to go back. It should be emphasized that these are patients who test negative for celiac antibodies, have normal duodenal biopsies with the gastroenterologist, and test negative for wheat allergy. Here is a wonderful study which identifies non-celiac wheat sensitivity via randomized controlled trial (a gold standard study design). Please note the study discusses irritable bowel syndrome. IBS is a diagnosis of exclusion which is used when no other diagnosis can be successfully made for chronic abdominal pain. The study confirms what I am clinically seeing in my office. Therefore, I am starting to use a trial of wheat restriction much sooner in my workup for these patients.