Spastic colon and irritable bowel syndrome are extraordinarily common in the United States and even more so in people with CFS and fibromyalgia. One of many causes of spastic colon would be wheat and other food allergies. Infections that are hard to diagnose on standard testing are another major cause.
Celiac disease can be viewed as a very severe wheat allergy caused by a mix of autoimmune problems in genetically susceptible individuals. It is present in approximately 1% or less of the population. When present though, it is important to make the diagnosis, as strictly avoiding wheat and gluten can result in dramatic improvement (including in the symptoms of CFS). The diagnosis can be made with a simple blood test.
Bottom line. I am starting to move toward recommending an anti-transglutaminase IgA antibody blood test in anyone who has persistent CFS and FMS despite 4 months of therapy with the "SHINE Protocol." Some physicians also look for a antigliaden antibody, but I do not consider this to be as reliable (especially the IgG antigliaden antibody, which I suspect may go up in other wheat allergies as well). The test is simple, is covered by insurance (like most blood tests), will give you a simple "yes or no" answer, and can be done at any lab.
Yield of Diagnostic Tests for Celiac Disease in Individuals with Symptoms Suggestive of Irritable Bowel Syndrome
Systematic Review and Meta-analysis
Alexander C. Ford, MBChB, MD, MRCP; William D. Chey, MD; Nicholas J. Talley, MD, PhD; Ashish Malhotra, MD; Brennan M. R. Spiegel, MD, MSHS; Paul Moayyedi, PhD, FRCP Arch Intern Med. 2009;169(7): 651-658.
Individuals with irritable bowel syndrome (IBS) report abdominal pain, bloating, and diarrhea, symptoms similar to those in celiac disease. Studies suggest that the prevalence of celiac disease is increased in individuals with IBS; however, evidence is conflicting, and current guidelines do not always recommend screening for celiac disease in these individuals.
We conducted a systematic review and meta-analysis to estimate prevalence of celiac disease in unselected adults who met diagnostic criteria for IBS. MEDLINE (1950 to May 31, 2008) and EMBASE (1980 to May 31, 2008) were searched. Case series and case-control studies that used serologic tests for celiac disease were eligible for inclusion. Prevalence of positive serologic indications of celiac disease and biopsy-proved celiac disease were extracted and pooled for all studies and were compared between cases and controls using an odds ratio and 95% confidence interval.
Fourteen studies were identified comprising 4,204 individuals, of whom 2,278 (54%) met diagnostic criteria for IBS. Pooled prevalence of positive IgA-class antigliadin antibodies, either positive endomysial antibodies or tissue transglutaminase, and biopsy-proved celiac disease were 4.0% (95% confidence interval, 1.7-7.2), 1.63% (0.7-3.0), and 4.1% (1.9-7.0), respectively. Pooled odds ratios (95% confidence intervals) for positive IgA-class antigliadin antibodies, either positive endomysial antibodies or tissue transglutaminase, and biopsy-proved celiac disease in cases meeting diagnostic criteria for IBS compared with controls without IBS were 3.40 (1.62-7.13), 2.94 (1.36-6.35), and 4.34 (1.78-10.6).
Prevalence of biopsy-proved celiac disease in cases meeting diagnostic criteria for IBS was more than 4-fold that in controls without IBS.