I am a 50-year-old male with multiple sclerosis and celiac disease. Recently, I have lost a lot of weight. Do you have any suggestions on how I can gain weight?

P.P.

The most important issue to deal with in your case is why have you lost weight recently. There are several possibilities in a person with both multiple sclerosis (MS) and celiac disease.

Some MS patients have a difficulty controlling the muscles needed for swallowing, because of neurologic damage, and are unable to consume enough food for adequate nutrition. Thus, they lose weight. This is usually an obvious cause. because the patient is aware of the difficulty in swallowing.

Celiac disease is a condition in which the small intestine loses its ability to absorb nutrients because of damage caused by an immune reaction to certain grains (namely wheat, rye, barley and oats). Patients with CD often have diarrhea and weight loss. By strictly avoiding foods made of the grains in question, most patients with CD experience dramatic improvement in their symptoms; they regain weight, and their small intestines revert to normal. The most common reason for recurrent diarrhea and/or weight loss in a patient with CD is nonadherence to this diet.

Other causes for persistent weight loss in CD include a condition known as refractory sprue, in which the disease is unusually severe and may require medications such as steroids and/or immunosuppressive drugs for control. A rare complication of CD is lymphoma of the small intestine. This can lead to symptoms such as worsening of the diarrhea associated with CD, weight loss and fevers. CD can also be complicated by pancreatic dysfunction and/or colitis, both of which can lead to significant weight loss. These disorders may be subtle, making diagnosis difficult.

It is important for you to see your doctor so that a careful evaluation can be done to determine why you are losing weight. Only after the cause of the weight loss is determined can proper therapy can be instituted.