Higher Rates of Celiac Disease in People with Multiple Sclerosis -5-10 times!!!

Is Celiac disease a "Brain" disease? Is Gluten sensitivity more commonly a brain disease than an intestinal disease, in this case villous atrophy? Here is more evidence that this may be so. And it may be due to increase levels of circulation auto-antibodies as is found in this study.

The study by a team in Spain, helps us understand the prevalence of celiac disease (CD) in a group of MS sufferers- 11.1%, but the team rightly questions both the myth of the typical presentation of the adult celiac victim (most don't have diarrhea), and the emphasis on the small bowel biopsy as the only means of diagnosis. I too don't think small bowel biopsy is the only means of diagnosing CD.

They don't report how many, if any, of their patients with a normal biopsy and positive serology were asked to go on a gluten-free diet, and how many improved on a gluten free diet.  They did recommend such a trial for 6 months to rule out CD. (This group would be "non-celiac gluten sensitivity" if they responded positively to the diet (and supplementation of nutrients, especially B vitamens and vitamins D)). Perhaps they will do this study in the future.

They rightly assessed first degree relatives and found a prevalence rate of 32%!

Jefferson Adams comments on the study in Celiac.com 05/11/2011 - People with multiple sclerosis and their first-generation relatives have higher rates of celiac disease than the general population, according to a report by a research team in Spain.

For the study, a research team led by Dr. Luis Rodrigo of University Hospital, Central Asturias, Spain looked at rates of serologic, genetic, and histological disease markers in 72 multiple sclerosis patients and 126 of their first-degree relatives. They then compared the results against data from 123 healthy control subjects.
The team found rates of celiac disease among multiple sclerosis patients that are 5 to 10 times higher than rates for the general population worldwide, which average between 1% and 2%.

The team found similar levels of HLA-DQ2 markers in both multiple sclerosis patients (29%) and controls (26%) (NS). They found eight multiple sclerosis patients (11.1%) who showed mild or moderate villous atrophy (Marsh III type) on duodenal biopsy. Results also showed that 26 of 126 first-degree relatives (32%) had celiac disease.Multiple Sclerosis patients also displayed increased frequency of circulating auto-antibodies such as anti-TPO in 19 (26%), ANA in 11 (15%) and AMA in 2 (3%).

The authors write:

"The findings from duodenal biopsies are still considered by most experts as the "cornerstone" or the "gold standard" for diagnosis of CD. However, this statement emphatic as it may sound, is currently being challenged, especially if we take into account the adult forms of CD. In cases with very high levels of anti-TGt-2 antibodies (>100 U/ml), the duodenal biopsy may be avoided, since in most cases (> 90%) such high levels are associated with the presence of villous atrophy [30]. When the histological results are normal, but the serology is positive and the clinical picture is suggestive of CD, the diagnostic uncertainty remains, and in such cases a gluten-free diet (GFD) could be recommended for at least 6 months, before definitely ruling out a CD."

See the full report here     BMC Neurology 2011, 11:31doi:10.1186/1471-2377-11-31

THE BURDEN OF CELIAC DISEASE IN THE MEDITERRANEAN AREA, 5B EU/year!

 

We really need to get more celiac's diagnosed to reduce the global financial, social, individual costs of celiac disease.
According to Luigi Greco (coordianator), European Laboratory for Food Induced Diseases (ELFID), Naples, Italy, Europe and the Middle East is not prepared for the burden of CELIAC DISEASE.
Because:
-the incidence is 1-44%( in at risk groups)
-the rate of undiagnosed is very high ranging from 7- 13 not diagnosed for everyone diagnosed. Some say 3% only are diagnosed.
-health care costs of an undiagnosed celiac is astronomical, being estimated at more than 5 Billions Euro/year.
-and health care costs are reported to decrease by 30% after diagnosis.
-death rate's for celiac's is 1.8 or almost double.

The aim of his teams work is to estimate the global burden related to undiagnosed Celiac disease in the Mediterranean Area, as computed by morbidity, mortality and crude health cost.

He writes:

Recent epidemiological studies show that the prevalence of Celiac disease (CD) had been underestimated, affecting not only Europeans, but also populations of the Mediterranean countries, such as Middle East (1-4) and North Africa(5-7), where its prevalence is similar to that of Western countries. Now CD appears to be a widespread public health problem, involving also the population of developing countries as well as of China (8,9,14).
In the Northern Africa Region and in the Middle East very high incidence of CD has recently been reported both in the general population and in at risk-group. These high frequencies are due to the wide consumption of wheat and barley and to the high frequency of the DR3-DQ2 CD predisposing haplotypes in these population (13,14). Prevalence of CD among low risk populations varies from 0,14% to 1,17% (15-17): 1%-1,3% in Turkey (18,19), 0,6%-0,96% in Iran (20-21), 0,5% in Egypt (22), 0,6% in Tunisia and Israel (23-24), <0,5% in Jordan, Lebanon, and Kuwait (1,10,16,25). Among high risk groups (patients with positive family history, insulin dependent diabetes mellitus, thyroiditis, etc) the prevalence of CD ranges from 2,4% to 44% assessed by serological markers and biopsy (26-27).
The use of wheat and other gluten-containing cereals is spreading all over the world, the consumption of wheat based pasta is increasing in Europe but also across Mediteranneum, where many countries are big producers also. The Italian nutritional style associated with the healthy features of the Mediterranean Diet was the cultural background supporting the widespread diffusion of the pasta. Unfortunately the side effect of this positive move has been the enormous increase of gluten intolerance.


Robust estimates of a prevalence of 1:100 individuals result in more than 5 millions individuals from the Euro-Mediterranean Countries affected by permanent gluten intolerance (Celiac Disease).
We also are aware that less than 1 every 7 adult individual and less than 1: 5 children affected are correctly diagnosed and treated (1,10-12). In the next 10 years we have to face about 5 millions cases in the Mediterranean area. This is the largest global epidemic of food-induced permanent disease in the area.
The health toll of this ‘epidemic’ unfortunately includes growth failure, infant malnutrition, gastrointestinal diseases, anemia and more than 20 associated symptoms and conditions. The risk of cancer in undiagnosed adults is significantly increased and the mortality is doubled in the total cohort of affected (28-33). The financial burden of this specific food related problem has to be estimated to more than 5 Billions Euro/year.
Very few countries from the Euro-Mediterranean Region are able to face this expanding problem : in many countries few cases are recognized, because of the low awareness and know-how to deal with the problem.
The diagnosis of CD brought a 30% reduction in direct medical expenditure. A similar 30% reduction in direct medical cost after diagnosis of CD was also reported by Green (35, 36).

There is more interesting information, including the references  here:

Management of Celiac Disease by Dr. Sidney V. Haas, A review by Kat

Over at www.scdkat.com , Kat writes a review and a summary of some of the important contents of the book by the Dr's Hass's. It emphasizes the basis of the treatment for celiac disease is a diet, and that diet has to be healing to the digestive tract. The most healing diet is careful not to have the wrong carbohydrates.

 

It is now known as the Specific Carbohydrate Diet, and refined by Dr. Natasha Campbell-McBride as the Gut and Psychology Syndrome diet (GAPS Diet). I have recommended both and only in rare occasions have I seen people thrive on any other gluten-free diet. GAPS diet works on so many different levels: lowers dysbiosis, lowers gut inflammation, heals the lesions, increases absorption of macro and micronutrients, lowers incidence of food allergies, lowers incidence of metabolic syndrome or Syndrome X and the resultant obesity, and so much more.

 

 

I just finished reading the

Management of Celiac Disease by Dr. Sidney V. Haas, the creator of the Specific Carbohydrate Diet, and his son, Dr. Merrill P. Haas. I found this book really interesting and packed with information. I took pages of notes but hope to summarize a bit more concisely here and then list some things I found most interesting to people following SCD now.

The authors cover a lot of the research on celiac disease up until the publishing of this book in 1951. At the time, gluten was not known to have any role in celiac disease (or maybe even gluten was not discovered yet) so a lot of the research done at the time was in the form of case studies using different dietary methods. It’s no surprise to me that Haas’ diet ended up having the most favourable outcome, since it is inherently gluten-free and provides adequate nutrition for someone recovering from celiac disease. I found this book quite easy to read without having any medical knowledge, so for anyone with celiac who is interested in reading about it, I highly recommend this book. (I bought mine from Digestive Wellness).

Read more at http://www.scdkat.com/2011/05/management-of-celiac-disease/#comment-2490.

 

Celiac Disease Prevents Recovery from Depression

"Undiagnosed celiac disease could be getting in the way of your recovery from depression".
So says Dr. James Greenblatt, MD, Chief Medical Officer of Walden Behavioral Care in Waltham Massachusetts, a psychiatrest and Assistant Clinical Professor at Tufts University Medical School, Department of Psychiatry.He goes on to write in his blog called The Malnourished Mind:

The health consequences of celiac disease, however, extend beyond gastrointestinal issues and may affect every organ system, including the brain.
Other consequences of celiac disease include:

• Anemia
• Anorexia
• Arthritis
• Behavioral changes
• Depression
• Fatigue
• Infertility
• Joint pain and inflammation
• Migraine headaches
• Missed menstrual periods
• Numbness and tingling of the hands and feet
• Osteoporosis
• Seizures and other neurological problems
• Skin lesions
• Tooth decay and discoloration
• Weakness
• Weightloss

Researchers have long observed an overlap between patients with celiac disease and patients who are depressed. Adolescents with celiac disease have a 31% risk of major depressive disorder, while only 7% of healthy adolescents face this risk.
But what does a disease that directly affects the small intestine have to do with a lingering sadness or listless mood? The answer is plenty. The intestinal damage wrought by celiac disease prevents absorption of essential nutrients that keep the brain healthy, especially zinc, tryptophan, and the B vitamins.

I encourage my patients with depression to be tested for celiac/gluten sensitivity disease with either a blood test or the stool tests and genetics offered at http://www.enterolab.com/.

Gluten causes Suicidal ideation in the gluten sensitive person!!!!!!! and other brain diseases.

Gluten has many negative effects on the brain and I found some well written information on the subject including one of the most common neurological diseases associated with gluten sensitivity, cerebellar ataxia online at the Brain Mind Center at Alpha Online, a division of Environmed Research, founded in 1984 at Vancouver, BC, Canada.

Suicidal ideation or the thoughts of suicide and nightmares are symptoms of gluten ingestion in the person with gluten sensitivity and we need to be aware of this.

Here's an excerpt from Gluten and the brain:

Celiac disease is the best studied form of delayed pattern food allergy caused by eating wheat and other cereal grains. A surprising range of disease is triggered by the proteins in these foods, collectively referred to as "gluten". Celiac disease may present as a vague illness, even a mental illness.
Patients often complain of  dysphoria with fatigue, difficulty in concentration, loss of recent memory, irritability, loss of pleasure and interests, often with sleep disturbances. Sleep and dreaming are influenced by food problems. Most people eat their major meal in the evening and snack at night. This food is digested and absorbed during the night and symptoms often emerge as you sleep. Some allergenic effects tend to peak at night - asthma, migraine, body pains, and itching are often at their worst. Sleep disturbances include difficulty falling asleep, frequent waking and nightmares. 

Gluten and Cerebellar Ataxia
One example of specific brain injury from eating gluten is cerebellar ataxia. The cerebellum looks after the coordination and smoothing of movements so that problems here show up as movement disorders. Gluten sensitivity, with or without classical celiac disease symptoms and intestinal pathology, is a treatable cause of cerebellar ataxia. Bushara et al reported: We investigated the prevalence of abnormally high serum immunoglobulin A (IgA) and IgG anti-gliadin antibody titers and typical human lymphocyte antigen (HLA) genotypes in 50 patients presenting with cerebellar ataxia who were tested for molecularly characterized hereditary ataxias. A high prevalence of gluten sensitivity was found in patients with sporadic (7/26; 27%) and autosomal dominant (9/24; 37%) ataxias, including patients with known ataxia. Patients with hereditary ataxia (including asymptomatic patients with known ataxia genotype) should be considered for screening for gluten sensitivity and gluten-free diet trials.

Read more Gluten and the brain:

Books on gluten sensitivity, celiac disease and gluten intolerance syndromes

Here is a list of some books that are available which can help in the understanding of gluten sensitivity and celiac disease. Be aware, however, that the research is uncovering new information at a rapid pace and some parts of some books may be out of date. I recommend also reading on-line news letters to keep up to date, such as http://www.celiac.com/  or www.glutensensitivity.org . Also www.beyondceliac.blogspot.com and www.scdkat.com
I use Dr. Campbell-McBride’s book as a diet manual after the initial diagnosis of gluten sensitivity or celiac disease. I find people who do a specific carbohydrate diet or GAPS diet (Paleo without gluten) initially, do the best.


Books:
The Gluten Connection by Shari Lieberman PhD
Dangerous Grains by Drs. Braly and Hoggan.
The Gut and Psychology Syndrome by Dr. Natasha Campbell-McBride, neurologist and PhD in Nutrition.
Healthier Without Wheat by Dr. Stephen Waggen
The Gluten Effect by Drs. Richard and Vikki Petersen
And
Cereal Killers by Dr. Ron Hoggan-2010


To your wellness and happiness.

Celiac Disease in Northern India More Common Than Previously Believed

There is a great misconception that the incidence of celiac disease varies from one ethnic group to another, being highest in the Irish. The truth is the incidence seems to be constant between races, about 1% of the population. In my opinion celiac disease is one manifestation of gluten sensitivity and some professionals believe the incidence for gluten sensitivity is around 1 in 20.

Here is a report that shows the incidence of celiac disease in northern India is near 1%. That means that celiac disease is more common than is recognized in India, and that rates are about the same as in other parts of the world, not lower, as conventional wisdom has held.

More evidence that physicians and health care professionals and the general population need to be more suspicious that health issues may be caused by gluten sensitivity or celiac disease.


Jefferson  Adams, over at celiac.com reports:
The research team set out to accurately estimate the prevalence of celiac disease in a specific Indian community. The team gathered data using a structured questionnaire administered via door-to-door visits. The questionnaire provided socio-demographic data and basic screening for features of celiac disease, such as chronic or recurrent diarrhea, and Anemia.

For children, the questionnaire included additional factors, namely short stature (linear height below 5th percentile for age) and failure to thrive/gain weight. All test subjects with positive blood screens and 10% of screen negative individuals were called for anti-tissue transglutaminase antibody blood tests.

All those with positive blood tests were invited to undergo endoscopic biopsy. The team diagnosed celiac disease on the basis of a positive blood screens, the presence of villous atrophy and/or response to gluten free diet.The team contacted 12,573 people in all. A total of 10,488 (83.4%) (50.6% male) agreed to participate. Screening showed 5,622 (53.6%) positive results. Of those who screened positive, 2167 (38.5%) submitted to anti-tissue transglutaminase antibody blood tests. The team also tested 712 (14%) subjects who had tested negative.

The data showed an overall sero-prevalence of celiac disease was 1.44% (95% confidence interval [CI] 1.22 1.69) and the overall prevalence of celiac disease was 1.04% (95% CI 0.85 1.25).

Source:

• Journal of Gastroenterology and Hepatology, March 2011 / DOI: 10.1111/j.1440-1746.2010.06606.x

Read more here at celiac.com