Wheat and Milk Opiate Withdrawal Is Real
Opiate withdrawal from discontinuing gluten and casein? Cautionary note: sounds absurd - until you see it. Evidence matters.
You might want to warn gluten sensitive, celiac and casein sensitive patients about this odd, frequent, and painful clinical phenomenon: Withdrawal after stopping wheat [gluten] or milk [casein] products can be painful, exhausting, and depressing, with weakness, anger, and “brain fog” as subsequent downstream effects that can drive the uniformed back to their comfort foods.
Their “comfort foods” can create opiate withdrawal. And remember: Gluten sensitivity is far more prevalent than celiac disease. In fact, celiac disease is end stage gluten sensitivity, taking the whole discussion of celiac disease to a completely different level.
More Recent Data Confirms This ’07 Report
See this more recent post/report on gluten sensitivity and celiac disease which teases apart new diagnostic methods to assess gluten sensitivity.
Case Review
I have a very interesting and refractory client in Ohio who has struggled for years with a variety of severe reactions to psych meds, suicidal depression, mercury toxicity, and became completely regressed on previous withdrawal of Prozac before I saw him in DC. With autoimmune issues in abundance and at times psychotic like feelings of loosing control we tested him for gluten/casein sensitivity, hit pay dirt with positive findings, and asked him to go on a gluten free/casein free diet [GFCF is the acronym].
He felt remarkably better at first, better than he had in years, then the withdrawal set in. Having had previous experience with addictive opiates prescribed for pain, he recognized signs of withdrawal immediately. First a note on the opiate receptors from Great Plains Laboratory:
The peptides from gluten [gliadorphin] and casein [casomorphin] are important because the react with opiate receptors in the brain, thus mimicking the effects of opiate drugs like heroin and morphine. These compounds have been shown to react with areas of the brain such as the temporal lobes, which are involved in speech and auditory integration.
Children with autism frequently seem addicted to wheat [gluten] and dairy [casein] products. Presumably, people with Autism and schizophrenia incompletely digest wheat and dairy products. These incompletely digested peptides are then absorbed into the body and bind to opiate receptors, altering behavior and other physiological reactions.
And one more reference here:
Notes From The Book: Dangerous Grains
Below is from Dangerous Grains by Ron Hoggan:
The addictive nature of gluten is often overlooked. For some, the first
days and weeks of following a gluten-free diet are characterized by
food cravings, disorientation, irritability, sleepiness, depression,
mental fogginess, fatigue, and/or shortness of breath.
If you are a member of this group, the very fact that you are experiencing many of
these symptoms should reinforce the need to exclude gluten from your
diet. These are common symptoms of withdrawal of detoxification from
gluten-derived opioid and brain neurochemical imbalances. The evidence
suggests that about 70 percent of celiac patients will experience these
symptoms when beginning a strict gluten-free diet.
See other withdrawal comments at Celiac Forums and the Gluten Free Forum.
Another Reference: Opiates Withdrawal We See In The Office
From the Journal of Biological Chemistry – Opiate Peptides From Food Proteins April 10, 1979, 254, 2446-2449
- The take-home appears simple: if these symptoms occur, do go more slowly on the GFCF diet, respect the opiate withdrawal process and support other nutritional and physiologic activities. As a side measure consider the importance of comorbid medical withdrawal issues from either casein or gluten. It may significantly altering neurotransmitter balance causing otherwise unpredictable cognitive and emotional symptoms.
Casein sensitivity, celiac disorder and gluten sensitivity now encourage a different treatment overview.
- I would welcome your experience out there with these matters so please do comment below, and weigh in on this important and overlooked matter.
- Thanks to my anonymous contributor from Ohio.
cp
Related articles
- Heroin, Oxycontin, and a whole wheat bagel (heartscanblog.org)
- Celiac & Autism (aspergerfamily.wordpress.com)
- Celiac Disease and a Gluten-Free Diet (bakeddessertcafe.wordpress.com)
- Gluten Withdrawal (trulyglutenfree.co.uk)
- Symptoms of Celiac Disease (everydayhealth.com)
- Heroine, Oxycontin, and a whole wheat bagel (heartscanblog.blogspot.com)
- Gluten-free, casein-free diet may help some children with autism, research suggests (sciencedaily.com)
- #Gluten Sensitivity Gaining Acceptance (trulyglutenfree.co.uk)
- Why are so many foods gluten-free now? (boston.com)
- What I need to know about Celiac Disease (celestehealthyliving.wordpress.com)
- Signs of Celiac Disease (foxnews.com)
- Celiac Disease and IBS: Differences and Similarities (everydayhealth.com)
Hi I have been in gluten withdrawel for close to 2 months and the fatigue in unbareble . is there anything i can do about it is this normal ? i smoke does that also affect the withdrawel . thanks
Cottage,
Withdrawal is significantly amplified by neurotransmitter imbalances caused by the previous bowel pathology. You weren’t absorbing nutrients correctly or else you would have had a s shorter, less intense drop.
Suggest several options:
1. Do consider a serious probiotic program and get your gut rehabed – get the broadest spectrum if you go OTC, if you connect with a practitioner familiar with gut rehab all the better.
2. Spend the bucks and get your Neurotransmitters tested. They will correct after months of health, but why not load those precursors on there and feel better faster?
3. Make darn sure you aren’t suffering, as many do, with other immunity maladies. Gluten is #3 in our offices in prevalence – Milk and eggs beat gluten in frequency and measurable imbalance in about 75% of cases. Gluten is only one tip of the iceberg – thanks to attention from the popular press.
cp
thanks for your reply this really helps , I am a bodybuilder and when i couldnt bodybuild i looked to ciggs for comfort i usually am really active person and im ready to start lifting again ( just no energy to do it !) I went to the phiefer institute for schizoeffective dis. and they ran a bunch of tests on me and found out im pyrolura i have high histamin and high coppper im now on mega doses of vitamins . wheres the best place to get NT testing done and how much does it usually cost? lol sorry to bug you there just limited info everywhere . thanks again ( and sorry about my grammer )
Cottage:
Have seen many folks with mood disorder downstream from trace elements and subsequent NT disturbances. I would call NeuroScience to see if they have a list of docs where you are, or go to Services here and set up a chat. NT would likely be quite helpful.
I have gluten withdrawal symptoms – what does that mean? Am I a celiac? Am I just allergic? If you have withdrawal symptoms does that make gluten an enemy? Confused.
If you have withdrawal you could easily suffer from an aspect of *addiction to gluten* – the point of this piece. Celiac is a far more advanced condition of villi deterioration and gluten sensitivity is far more common. See IgG notes by Searching here for more on these several issues.
I’ve now been gluten free for just under a week, and I’m feeling it already! There were stomach disturbances to start with which have now improved, but I’m still getting nausea, brain fog, sometimes almost a panicky type of anxiety and very emotional. The dreams are getting stranger! Although I feel hungrier and definitely more tired come the evening there have been no cravings as yet. Perhaps partly because I’m not entirely cutting all sugar out yet and am having potato snacks to help soften the blow, I’ll cut those out later! Thank you for the info here, it helps to know I’m not going mad.
)
Sara,
It’s pretty spooky to see these symptoms downstream from foods you love. Hang in there and always remember: stay persistent on the path, if you don’t succeed you’re very likely missing something.
cp
Sarah,
Likely you will feel a bit mad when you take the next step, if indicated, on casein – the most common allergen we see in our offices daily.
Sorry, hope it works out without this next step!
cp
Mary,
Absolutely: fibro and gluten/casein are often connected. There are many reasons you are having withdrawals including the strong possibility that you have other immune system dysregulations in the first place.
Withdrawal can last months if you don’t take care of your gut, add gut healing supplements and get rid of any other food corruptions, measured thru IgG.
cp
Mary,
Strongly recommend you go to my CoreBrain Books listing on the nav bar here and go to CoreBrain Training, then below that to Neurotoxins etc, and look at the book: Why am I always so tired? by Dr Gittleman – My very distant speculation is that you might have a problem with trace element imbalances, and the withdrawal is highlighting other possible issues explained therein.
cp
I saw a commentor who was angered by the comparison of gluten etc. to drugs.
While, no, you don’t get a legitimate “high” from eating a piece of bread, I can say that from experience I got a rush of “good feelings” and a feeling of satisfaction that other food doesn’t typically offer me. I came to realise eventually that this was an addiction, and that I very likely had an intolerance or allergy. About a week ago I stopped consuming gluten and have noticed that I have been feeling dizzy (particularly at night). This feeling of dizziness can be very accurately compared to withdrawals from a drug I had been taking for anxiety (Effexor…ironically, I believe the anxiety was an issue BECAUSE of gluten…I have found that overall my mental situation has improved after stopping gluten but I have been having occasional anxiety attacks…can this be connected to the withdrawal as well, Dr Parker?). Mind you, the effect isn’t as strong as it was with the drug withdrawal (yet…hopefully it doesn’t get worse!), but it is there and it is real. If you really think that addictions are limited to drugs, think again. Just look at people who are addicted to games like World of Warcraft, or even social networking like Facebook. These are accompanied by their own slew of withdrawal symptoms.
I’ve been gluten-free for about 12 days now.
I’m 21(female) and for the first time in my (albeit short) life my stomach does not hurt *all the time*. I felt the effects on my stomach almost immediately (and the effects on my wallet – ouch). However, the withdrawal is just now reaching its peak. Last week I just felt kind of… weird, it’s difficult to explain. I have chronic pain / fibromyalgia / migraines / anxiety / depression and I hope that my new eating habits will eventually help all of these health ailments, but right now it’s almost unbearable.
I’m extremely irritable, had a ‘not normal’ headache for the past few days, been dizzy/more tired than normal, having trouble sleeping/nightmares, feeling terribly unbalanced mentally, and had a low fever for two days. I’ve also been eating less, but my hunger is satisfied by a smaller amount of food.
Even though the process for me very painful physically and psychologically I am definitely sticking with this diet. I just hope these awful feelings don’t last too much longer.
@Larad Just time for a short supportive remark: Stay on it, you will get better, and when off, don’t go back. If troubles persist with the fibro I strongly recommend an inexpensive test to assess Trace Element imbalances and tweak your electrolytes… will be blogging more about this soon so stay tuned.
cp
We just did testing and found my daughter is right on the bubble of a casein intolerance, but showed gluten was OK. (also showed high yeast, and high strep levels) Doctor wants her to go off dairy, and we have for 2.5 days now. She has a fever today, and her back has been itching. They also did skin testing 2 days ago (skin test was negative, but the blood test showed the intolerance). Could her fever be linked to going off of dairy, and/or the skin testing? How long should it take to see positive results in her digestion and sensory issues?
@bunewkid Thanks for asking, – it’s unlikely. Her resistance is likely down with the immunity challenges in the first place, and it’s not likely a withdrawal issue. Usually improvements occur in 1-2 weeks, often days, if not complicated by other undiscovered contributory factors.
cp
im going crazy i have been gluten free for two weeks and feel like crap. my head has hurt for 5 days a weird headach tension almost and sick to my stomach anxiety and lightheaded foggy… i also have crohns disease and is why im stopping gluten. how do i know this is gluten withdrawl and not crohns or something seriouse i should go to doctor about… is this gluten withdrawl is it normal to have weird headaches
@SarahManning This kind of difficult Gluten withdrawal is a key finding, almost always seen with Crohn’s, or, in fact, any significant immune challenge with the bowel dysfunction. The problem is at once simple and complex: the Transit Time changes and associated neurotransmitter balance remarkably deteriorates the specific neurotransmitter levels – measured and witnessed hundreds of times, not once in a while. Several interventions need to happen almost simultaneously to correct the withdrawal experience:
1. Measure qualitative, not quantitative, IgG and correct your diet for any other immunity issues such as milk or eggs which will contribute to additional ongoing imbalances.
2. Correct neurotransmitters specifically as measured with neurotransmitter levels with urine, we use NeuroScience and Pharmasan Labs.
3. Use psych meds to help collect the neurotransmitters on the short run to help with the emotional chaos that comes from the withdrawal.
4. Remember that the opiate receptors are part of the problem, but my sense of it from the office work is that the greater the neurotransmitter imbalance the greater the problems going off.
cp
stopped drinking milk 2 days ago. couldn’t sleep last night. feel light headed and pressure in the brain today. minor speech impediments. hopefully doesn’t get worse.
@DandateDate The good news: it should get significantly better quickly – if it doesn’t your neurotransmitter system is corrupted by leaky gut and insufficient chickens at the synaptic ranch… all measurable and correctable, so chin up!
This is so bizarre. This could possibly explain so much about my entire life. I have thought that I have high functioning autism for about 10 years now though I should probably have been able to tell from the ways in which I was different many years before. I used to drink so much milk that my mother would stop me drinking milk, at one point 6 pints a day. I did use heroin in my youth for a number of years but then one day decided to stop and really didn’t have the same level of difficulty that most people seem to exhibit. It was easier to turn my back on than smoking.
I left that life behind about a decade ago but last year I found that I couldn’t eat wheat or dairy any more. I was collapsing and had to sleep through lunch breaks and couldn’t sit up in a chair. Since having stopped wheat and milk I have become an obsessive eater of raw oats and have also started using over-the-counter pain killers containing codeine a little more than I should despite having been drug free for a decade. This article is therefore incredibly fascinating to me. I will be researching this area far more.
Harry,
You are an excellent candidate for more clear testing – specifically a low cost [we give you the test and you pay 46$] Tissue Mineral Analysis, – we do charge for reading it. It tests, as we’ve seen in many opiate abuse folks, 30 trace elements and a convincing number of heavy metals, any of which could provide serious feelings of unbalance and thereby become relapse triggers.
cp
Hello Dr. Parker, Thank you for further exploring this issue. I feel as though I am in the small amount of people that are experiencing extreme withdrawal symptoms of going gluten free. I especially gravitated to the quote from Dangerous Grains which mentions “shortness of breath”. The fist time i found out i was allergic to wheat was on the farm while my dad was harvesting it, I had my first asthma attack at 6 years old. For some reason eating wheat didnt ever seem to trigger my asthma, but breathing the dust from wheat during harvest was killer to me. Fast forward to now and I am 32 years old, normal weight, and addicted to beer and all types of bread. I went on the atkins diet a few years ago which was accidentally gluten free and after 5 days became so lethargic and foggy, and ended up at the drs office for extreme breathing difficulties and wheezing. It seemed as though as soon as i began eating carbs again I was back to my normal self. Now here I am attempting to go gluten free again because I would have shortness of breath just after drinking 2 beers! I know I was extremely addicted to breads and beer because that was mainly all i craved and would consume. It has now been 2 days and I woke up in the middle of the night with shortness of breath out of nowhere. I had to take my albuterol inhaler to get back to normal. My question is can the withdrawals of quitting gluten cause extreme shortness of breath and is it dangerous for a person like me to quit cold turkey as I have done? I dont want to be addicted to breads the rest of my life and have ibs and asthma from drinking beer but I dont know how i can live through these withdrawals that seem just as bad?
JJ,
Likely you have, at your young, age a few more contributory factors going on in addition to straight gluten withdrawal. Confirmation of shortness of breath [SOB] here and multiple sites: http://www.wellsphere.com/healthy-living-article/adult-diagnosed-celiac-disease-the-challenges-of-going-gluten-free/537413
The longer I’m working with casein and gluten withdrawal the more I am impressed by the serious aggravation of symptoms following neurotransmitter imbalances and trace element imbalances secondary to the relative malnutrition over years. You can see the deficiencies on testing. Those several possibilities [many neurotransmitters and many trace elements] can significantly contribute to the worst withdrawal symptoms.
My suggestion: measure and correct the side issues, then your recovery from gluten is quite possible, often in a short period of time.
cp
Dr. Parker, I first wrote to you in 2010, perhaps on this very thread. First, I want to thank you because after dealing with a myriad of well meaning physicians, even GI’s, in the past couple of years, I think that you may be one of the only doctors who “get it.” I hope that more of you will spring up.
When I wrote to you two years ago, I had just gone gluten free due to severe brain fog/dizziness issues. I soon found my symptoms heightened due to withdrawal, but after a few weeks, everything calmed down and I began to feel much, much better as long as I did not ingest gluten. But the biggest strides in my feeling of well-being and tremendous health (i.e., today feeling like a 20 yr old @ the age of 57), came only after I also totally removed casein and soy from my diet back then. To this day I get dizzy and nauseous ingesting even an accidental trace of soy. I’ve developed a better tolerance for some forms of dairy but I avoid it anyway, and of course, I am very careful about no traces of gluten. Needless to say, I don’t eat out a lot, but I miss that.
I have not been diagnosed with Celiac and will never know definitively (went gluten free before undergoing testing) however I know I inherited the gene from one parent that predisposed me to that disease. If after two plus years of strict avoidance and still reacting to the secondary intolerance, SOY, is it possible that I could someday build at least a tolerance to that particular cross contamination? Does my genetic disposition play any kind of role in my problems with casein and especially soy as intolerances secondary to gluten?
Again, thanks for all you do.
Karla,
My take at this time, having for years witnessed folks after second level opinions raised regarding going off their diets, stay the course for your lifetime. My bias arises from multiple clinical events wherein we tested for IgG, found the problems, corrected the diet, and then, back home a nutritionist or other doc said: “You’ve been off it ___ mos now [fill in the blank], so no problem, just reintroduce those foods slowly.” The big problem with reintroduction is simple: IgG reactions often DON’T show symptoms, so the feeling is: “Hey, I can’t feel any deterioration, I must be OK.”
Don’t mix IgG apples with IgE oranges: IgG reactions differ from IgE reactions as noted in several blog posts and Cinchcasts here. IgG you don’t feel, so you’ll just go back to the slow corruption of your gut as previously, and you’ll most likely return to live downstream from malabsorption and cytokine storms that interfere with neurotransmission… but you don’t feel completely sick. I can’t even begin to estimate how many times I’ve seen these issues clinically.
Hang tough, you’ll be grateful in the long run.
cp
Hi,
i have been gluten free for about a week now i started developing alopecia and hi yeast fungal rash on my neck and shoulders so i decided it was time to start gluten free i have a sensitivity already known and took a celiacs test as well but have not gotten results yet i took that about 2 months ago.. could this alopecia and fungal rash be because of the gluten? im also having horrible side effects with the headaches so tired and feeling nauseous today..
Abby,
All of these symptoms can reside downstream from IgG challenges with gluten, – but remain ever vigilant and prepared as follows: in my office we see far more milk and egg allergies, so just consider further IgG testing.
cp
Hi Dr. Parker,
I am a Pharmacy student who is having trouble doing well in school due to severe brain fog, memory loss, fatigue, and chronic orthostatic intolerance. All of these symptoms began suddenly after I ate a big piece of naan bread with chocolate hazelnut butter and peanut butter on it. I mention those foods because I’m fairly certain I’m intolerant to all of them (even the chocolate). I’ve considered the possibility of a immune overreaction due to the fact that I had been exercising strenuously on an empty stomach prior to jamming all of those allergens down my throat.
Anyhow, there was clearly gluten in the naan bread and my symptoms have been getting worse despite cutting all of those foods out of my diet (except the gluten). I just recently (5 days ago) cut the gluten out (plus casein, eggs, others) and have been feeling worse (more headaches, brain fog). Am I going through withdrawal? All I’m eating right now is tons of rice, some olive oil, grilled chicken, and some GF potato chips. Could I be intolerant to any of those things?
It has been 6 months since I felt clear-minded (this condition is chronic) and I am at the end of my rope. Should I continue with this GFCF diet or do you think I’m wasting my time and need to be doing something else?
Thank you.
PAT,
Excellent questions all.
1. Never wrong or waste of time to address offending antigens.
2. Withdrawal is highly likely especially if you have had this prob for years.
3. Don’t even mess with the antiquity of the “elimination diet”- you’ll be like an
old bloodhound laying in the sun trying to bite at flies. You’re a deep science
guy, just measure IgG… and in your case IgE for wheat, chocolate and whatever. No
science is nonsense. You already know that. In brain matters neuroscience testing is
essential. See this playlist if you haven’t already checked it out. http://bit.ly/mindgut
4. Just what to do with the withdrawal varies – may need a bit of an antidepressant
to cover serotonin imbalance, or a benzo to cover GABA… just speculation here,
more careful review would be instructive.
Summary:
Measure, then correct instead of fiddling around. Commonwealth Labs will cover the big three in detail for about 8$ each food.
For those with insufficient funds we rec the following: Milk, Eggs and Wheat, then Peanut, Soy, and Almond to see what the switch
milk might be – total about 48$.
cp
I am curious as to any reports of heightened aggression when going off of gluten?
My oldest son has FPIES and milk proteins are the main culprits. Even though we were told he would outgrow them by 2yrs old, he didn’t and unbeknownst to us we gave him milk for years before removing it and discovering he had FPIES. Well, according to his pediatrician he shows all the “classic” symptoms of Celiac’s but, when they test him 1 – 2 times a year, he always tests negative. They were so convinced he had it, they scoped him from top to bottom. So, after several years of testing I finally just asked if going gfcf completely would be the most advantageous to him. Of course he answered yes.
My son is a special needs kiddo. Tourette Syndrome, ADHD, OCD, Sensory Processing issues, ODD, etc. Once diagnosed with Asperger’s, which as you may know no longer exists in the DSM. Anyway, when we removed him from milk day 4 or 5 he went ballistic. It was really awful but, within the week, he began to eat more, the dark circles under his eyes went away, his personality completely changed within the following weeks.
I ask because we are about 4 days into GFCF and he’s become worse in behaviors than he’s ever been. Today he carried on full out screaming in his OT/PT/ST’s office! People in the other offices were coming out to look even! I’ve never seen him this bad since removing him from milk proteins. He’s also extremely hyper, more so than he’s been in a long time. Maybe I’m grasping at straws but, could this maybe be a result of removing gluten now too? As I said once before, when he was removed from milk proteins he got a bit aggressive but, it’s been some years since then. I was just curious if a detox from gluten could cause such a severe reaction.
Thanks for your time.
Em,
The short answer: with gluten or casein withdrawal: Expect the unexpected. Highly likely that withdrawal is the problem, and more profound withdrawal symptoms are often encouraged by the remarkably imbalanced neurotransmitters so often seen downstream from the *chronic* relative malabsorption [even though a child]. I also think you might actually get an IgG test for him, as it didn’t sound like you have a full IgG on your table yet, – and so often other contributing factors can create significant problems. In our offices we see eggs second to milk, and gluten a slow third in that lineup of frequency. A profound egg problem on top of withdrawal could aggravate issues – and then do think about trace elements as well – trace elements play an important part in the enzyme activities that balance neurotransmitters and are often completely diminished by problems like FPIES [see the link for those unfamiliar].
Hope this helps, Em,
cp
Thanks so much for your reply. No, we’ve not gotten an IgG yet. My son’s pediatrician would not do any of those tests. He’s fought me a lot of the way through. I’ve since switched pediatricians, just a few days ago really, to one who is willing to put away the prescription pad until after she’s listened to my concerns! I had an appointment to meet with her the other day and she also suggested things like trace elements and eggs as well. Which made me feel like we might finally have the right general pediatrician! Now, we work on the neurologists, psychologists and the developmental behavioral pediatrician and hopefully we can get a great team together eventually.
Thanks for taking the time to respond. It’s nice to see your videos and read your blog and feel like there are doctors out there who actually “get it”.
Those of us who get it are growing steadily in numbers: Neuroscience Evidence Changes Thinking!
cp
Hello, I started a gf diet because i have me/cfs. After about three weeks my speech began to slur, then my tongue swelled up and then once it went down i coudnt form words well. Went to a and e, they did a brain scan and are saying its likely its ms. My speech is fine again and i feel better for the diet but i am terrified. Do you think this could have been some temporary brain swelling from the withdrawal of gluten? Thank you for any help.
Leis,
Highly unlike that was related to withdrawal from Gluten – more likely in the process of detox some other elements were mobilized on some level and you had a toxic reaction. If you had/have MS, that reaction didn’t cause it, it likely only aggravated a quiescent pre-existing condition. Very unusual. Your prognosis is more encouraging and positive in the sense that it took a real insult to reveal the issues. Strongly recommend IgG testing and Trace Element Review.
cp
Thank you very much for your reply. I was hoping it was down to gluten withdrawal as im terrified at the ms diagnosis. My speech is totally normal again and head clearer. I have had cfs for 11 years. Could the spots they seen on the brain scan be from gluten ataxia?
What kind of elements could have caused a toxic reaction? Another food allergy or medication or something thats been trapped in my body a long time? Im very worried and appreciate your help.
Leis
Leis,
We could speculate for the next 10 years, but speculation will only serve to add more anxiety. Reality has some answers – strongly suggest biomedical inquiry for real facts, real data. In the meantime your educational interests would be served by reading about Herxheimer Reactions here – keeping in mind that herx reactions can also occur in simple detox processes not associated with bacteria.
cp
Thank you for your help Dr Parker. I will read the link you suggest.
Best wishes, Leis
Leis,
And PS, spots on the scans, depending on the scan type, can be related to injury from Gluten – and can be reversible with careful attention.
cp