Posts Tagged ‘celiac disease’

If I’m sensitive to gluten, can I eat corn or oats?

Thursday, March 11th, 2010

This becomes an important question when someone realizes how much they benefit from avoiding gluten due to celiac disease or non-celiac gluten sensitivity. The evidence suggests that corn (maize) has to be considered on an individual basis. It is possible, but not certain, that you may react to corn when you are sensitive to wheat gluten.

GUTConsider this study that was published in the journal GUT, An International Journal of Gastroenterology and Hepatology. The authors investigated how nitric oxide is part of the intestinal inflammatory reaction reaction to gluten, and how it relates to the white blood cell response. They noted this in their conclusion:

“Mucosal activation of neutrophils and eosinophils [white blood cells] precedes pronounced enhancement of mucosal NO [nitric oxide] production after rectal wheat gluten challenge in patients with coeliac disease. Some of our coeliac patients displayed signs of an inflammatory reaction, as measured by NO and granulocyte markers, after rectal corn gluten challenge.”

So it depends on the individual. The more serious your condition the more important it is to check yourself for corn sensitivity with the immunological ‘gold standard’—a properly managed elimination-provocation protocol.

Scandinavian Journal of GastroenterologyWe are also bereft of a perfectly decisive indication  for oats because rare individuals can react, though this study published in the Scandinavian Journal of Gastroenterology indicates that most celiac patients can tolerate them. First the authors note that…

“We have…identified three adult coeliac disease patients who developed a flare of active coeliac disease after ingestion of oats, which suggests that oats might not be entirely innocent in coeliac disease.”

They set out to compare the immune response to oats and wheat by comparing production of the main intestinal antibody (IgA) that participates in the reaction. Although other immune activity was observed,…

“No significant differences were found in IgA against oats in oats-eating and non-oats-eating coeliac disease patients.”

Their conclusion:

“Ingestion of oats does not cause increased levels of IgA against oats in adult coeliac disease patients on a gluten-free diet. The findings support the notion that most adult coeliac disease patients can tolerate oats.”

Note the “most”. And even if you are not sensitive to oats, it is important to be sure that they are certified gluten-free. Otherwise they can be contaminated with gluten during storage, transport, processing and packaging.

What about blood tests for food allergies? Too many variables influence antibody tests for them to give a reliable indication. If you have a serious condition with an autoimmune basis, it’s best to consult with a functional medicine practitioner who can  help you through an elimination-provocation protocol (eliminating and re-introducing foods), and who knows how to use objective lab tests to profile your immune imbalance.

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Gluten sensitivity and brain disease: neuronal transglutaminase

Monday, March 8th, 2010

Annals of NeurologyThe authors of this paper published in Annals of Neurology make an important statement:

“Gluten sensitivity typically presents as celiac disease, a chronic, autoimmune-mediated, small-intestinal disorder. Neurological disorders occur with a frequency of up to 10% in these patients. However, neurological dysfunction can also be the sole presenting feature of gluten sensitivity.”

Antibodies directed toward transglutaminase in the gut are a well-known diagnostic feature of celiac disease. These investigators have identified another member of the transglutaminase family:

“…a novel neuronal transglutaminase isozyme and investigated whether this enzyme is the target of the immune response in patients with neurological dysfunction.” They found that “Whereas the development of anti-transglutaminase 2 IgA is linked with gastrointestinal disease, an anti-transglutaminase 6 IgG and IgA response is prevalent in gluten ataxia, independent of intestinal involvement.”

(Ataxia is loss of the ability to coordinate muscle movement, especially as it appears with difficulty walking.) Their conclusion:

“Antibodies against transglutaminase 6 can serve as a marker…to identify a subgroup of patients with gluten sensitivity who may be at risk for development of neurological disease.

If you are gluten sensitive, you can have neurological disease without celiac involvement.

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Gluten can cause brain lesions like ALS

Saturday, February 13th, 2010

American Journal of NeuroradiologyHere is another alarming paper published in the American Journal of Neuroradiology reporting a case of apparent Amyotrophic Lateral Sclerosis (ALS, also known as Lou-Gehrig’s Disease) that was caused by a reaction to gluten. ALS is a particularly vicious autoimmune disease that attacks the central nervous system, typically following a terminal course. The authors note regarding celiac disease that “Initial symptom presentation is variable and can include neurologic manifestations that may comprise ataxia, neuropathy, dizziness, epilepsy, and cortical calcifications rather than gastrointestinal-hindering diagnosis and management.” I’m sure they were relieved to find that “MR imaging findings suggestive of ALS improved after gluten-free diet institution.” (MR = magnetic resonance)

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Increase in death risk from gluten-related gut inflammation

Tuesday, February 2nd, 2010

JAMA 091609This paper published in JAMA (The Journal of the American Medical Association) recently examined the risk of death associated with celiac disease. The investigators found a modest but significant increase in risk of death not only with celiac, but also with latent celiac disease and small intestine inflammation. They note that “This risk increase was also seen in children.” The take home message here is that even in the absence of gastrointestinal symptoms (”latent celiac disease”), there is an overall negative impact. The authors’ conclusion: “Risk of death among patients with celiac disease, inflammation, or latent celiac disease is modestly increased.”

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Atrial fibrillation and subclinical hyperthyroidism (and gluten sensitivity)

Tuesday, December 8th, 2009

It’s necessary to bear in mind when dealing with atrial fibrillation that subclinical hyperthyroidism is a common cause. Subclinical means that there are symptoms from excess thyroid hormone activity even though the lab values appear normal. There are a plethora of recent studies that investigate this phenomenon; here are a few. The authors of the first paper state: “Overt and subclinical hyperthyroidism are both well-known independent risk factors for atrial fibrillation.”

  1. High-Normal Thyroid Function and Risk of Atrial Fibrillation
  2. Activation of Electrical Triggers of Atrial Fibrillation in Hyperthyroidism
  3. Atrial fibrillation and heart attack associated with subclinical hyperthyroidism
  4. Atrial fibrillation associated with exogenous subclinical hyperthyroidism
  5. The mechanisms of atrial fibrillation in hyperthyroidism
  6. Effects of Thyroid Hormone on the Cardiovascular System
  7. Association Between Serum Free Thyroxine Concentration and Atrial Fibrillation

Now the plot thickens. Here is a paper recently published in Nature Reviews Endocrinology discussing the link between celiac disease (gluten sensitivity) and autoimmune thyroiditis. Here is another, fresh off the presses, from the journal Gut. One more for now: this paper published in the journal Thyroid demonstrates that the antibodies involved in celiac disease also bind to thyroid follicles.

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Brain lesions like Lou Gehrig’s Disease from reactions to gluten

Tuesday, December 1st, 2009

Here is another report just published in the American Journal of Neuroradiology describing a case of white matter (brain tissue) lesions suggesting amyotrophic lateral sclerosis (ALS, Lou Gehrig’s disease) that turned about to be a neurological manifestation of gluten sensitivity. Of special note: “MR [magnetic resonance] imaging findings suggestive of ALS improved after gluten-free diet institution.”

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Schizophrenia and autoimmune diseases

Tuesday, November 24th, 2009

This important paper was published in the American Journal of Psychiatry. The authors state, “Thyrotoxicosis, celiac disease, acquired hemolytic anemia, interstitial cystitis, and Sjögren’s syndrome had higher prevalence rates among patients with schizophrenia,” and further conclude, “Schizophrenia is associated with a larger range of autoimmune diseases than heretofore suspected. Future research on comorbidity has the potential to advance understanding of pathogenesis of both psychiatric and autoimmune disorders.” In my experience, the autoimmune component must be recognized and treated. A couple related studies:

  1. Vitamin D deficiency and schizophrenia published in Schizophrenia Bulletin in April, 2009
  2. Gluten sensitivity and schizophrenia also in Schizophrenia Bulletin in June, 2009
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Eosinophilic cystitis: a cause of urinary symptoms in males

Saturday, November 21st, 2009

Men, difficulties with urination including pain, retention, even bleeding are sometimes not from the prostate. In a paper published in the Archives of Pathology and Laboratory Medicine the authors state: “Eosinophilic cystitis (EC) is an inflammatory condition of the bladder that has been linked to food allergens, infectious agents, drugs, and other genitourinary conditions…[it] represents a response to a variety of agents and may often be overlooked.” As described in this paper published in Urologia Internationalis, “The clinical presentation of EC is varied. When the lesion is located at or near the bladder neck, it may present as urinary retention.” (Ladies, this condition afflicts you and children as well.)

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Autism and celiac disease

Friday, November 20th, 2009

These authors from the Child Neurology and Psychiatry Unit, Department of Neurological Sciences, University of Bologna, Italy comment on the association of autism with celiac disease in the Journal of Autism and Developmental Disorders: “In conclusion, our data suggest that, within the context of research, the screening for CD [celiac disease] is recommended in all children with autism, even if no gastrointestinal symptoms are present.”

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Range of neurologic disorders with gluten sensitivity

Friday, November 20th, 2009

This paper published in the journal Pediatrics discusses some of the neurological disorders that can be present with celiac disease. It’s important to be aware that non-celiac gluten sensitivity can manifest these and more. The authors conclude: “This study suggests that the variability of neurologic disorders that occur in CD is broader than previously reported and includes “softer” and more common neurologic disorders, such as chronic headache, developmental delay, hypotonia, and learning disorders or ADHD.”

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