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Celiac Disease

Children, Gluten, Sleep Apnea and Headaches, Oh My!

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gluten sensitivity in children
duckman76 /Dollar Photo Club

Here’s the reality of human physiology; we will NEVER understand how complicated it is.   Gluten sensitivity’s effect on the brain falls under this category.

There’s no doubt that many of us has a grasp on small amounts of how the body works, but the big picture is just too big for any one of us to understand fully.  It’s kind of like–I can drive around here in Phoenix quite well and know where I’m at or at least how to get to where I need to go.  But drop my in Dubai without a map or GPS and I’m pretty much screwed (especially since my Arabic is a little rusty…).

That’s a pretty good analogy to the human body and its complexity.  The most that any of us can hope for is a glimpse of insight into how it works and how we, as physicians, can help patients heal and live full lives.

This is one of the reasons why my passion has always been normal physiology and how the lifestyles we are SUPPOSED to be living impact that.  I figure it’s easier to match how we are designed to live then to figure out the details of that process.  Sort of like recommending more vegetables in your diet (because it’s the right thing to do) instead of understanding how glucosinolates in broccoli assist detoxification of environmental contaminants.

Just to complicate things even more, every system in the human body communicates and interacts with every other system.  The connections between the gut and the brain are particularly strong.  This is why treatment for any “brain disorder” should always include a look at the gut.

While this relationship may seem a little strange at first glance, the reality is that the gut is considered the body’s “second brain” since its production of neurotransmitters is as heavy as the brain.  As an example, 2/3 of the body’s serotonin is produced in the gut NOT the brain.

To further complicate matters, your DNA codes for about 25,000 different genes that make all kinds of different proteins to make sure your body is working the way it is supposed to.  Just in case that sounds a little overwhelming, the bacteria in your gut, collectively, have about 3 MILLION genes, all equally capable of making proteins that effect your health and risk of disease.

With this as a background, we can now look at just how absolutely jaw-dropping amazing this particular study is.  It brings together so many of these concepts that it is going to make your head spin.  In this small study, researchers looked at 19 children who had newly diagnosed celiac disease confirmed through an intestinal biopsy and followed them for 6 months while on a gluten free diet.

In these children with gluten sensitivity, there were some disturbing findings:

  • 37% of the children had headaches that affected daily activities.
  • 32% demonstrated symptoms of obstructive sleep apnea.
  • 48% of the children had abnormalities on EEG (a test using electrodes to check brain activity).

These findings clearly indicate that gluten (essentially a gastrointestinal condition) was having very definite negative effects on the brain.  And make no mistake–these are serious conditions to be found in children.

Luckily, the researchers then found some amazing things that were affected by 6 months of a gluten free diet:

  • The headaches disappeared in 72% of children.
  • EEG abnormalities disappeared in 78% of the children.
  • ALL children no longer had symptoms of obstructive sleep apnea.

As I mentioned, this is a small study.  However, it does link to and support other studies that have found an increase in migraine headache in those with gluten sensitivity, which gives it more weight.  While many have called the gluten free diet a “fad” I think these naysayers have managed to miss much of the medical literature linking gluten with a long list of health problems.

Even better, this is a DIETARY change with no real downside or side effects.  It is an approach that truly gets to the root of the problem rather than just glazing over the symptoms with dangerous medications with a long list of side effects.

Also, while this study only evaluated biopsy-confirmed celiac disease, which is at the far end of the spectrum, you can bet that lesser degrees of sensitivity will also link to neurological damage.  It will just be more subtle.

 

C-sections and Gluten

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IS C-SECTION TO BLAME FOR INCREASED RATES OF COMMON INTESTINAL DISEASE?

The incidence of celiac disease (allergy to the gluten component of grains like wheat and oats) continues to increase, and we now see “gluten free” in stores and on restaurant menus everywhere.  This can be a serious problem, leading to a higher overall mortality rate for those that continue to eat gluten, most likely because of the subtle inflammation that results over the course of decades.  The increase is believed to result from two phenomenia–increase in the presence of Candida yeast from antibiotic used combined with overall higher levels of gluten from the use of nitrogenous fertilizers in commercial farming.  The idea that C-section contributes to this (increased risk 80%) is likely because it is known that the bacterial flora in C-section babies is different than that of vaginal births.  Yet another ramification of the medicalization of childbirth.

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Reflux esophagitis in coeliac disease: beneficial effect of a gluten free diet – (03-18-03)

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Reflux esophagitis in coeliac disease: beneficial effect of a gluten free diet.

No need to make lifestyle changes like avoiding wheat–just take acid suppressive therapy. After all, acid is not important for digestion of proteins, activation of multiple digestive enzymes, activation of multiple anti-cancer compounds in foods, absorption of nutrients like B12, iron and certain types of calcium and sterilization of bacteria–so what’s the big idea of shutting it down? On a more common sense note, a trial of a wheat free diet is a very good idea for any patients with reflux. Many of these patients also respond well to addtion of stomach acid, contrary to popular (but wrong…) belief.

Gut — Abstracts: Cuomo et al. 52 (4): 514

Click here for more information.

Organ-Specific Autoantibodies and Celiac Disease Patients – (10-16-00)

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Organ-Specific Autoantibodies and Celiac Disease Patients

This is yet another example of how important it is to determine food allergies and avoid those foods we’re allergic to. Wheat is high on the list of common allergies, along with corn and milk. This article also brings to light the systemic affects of food allergies; effects are not always what a person would normally think of. No hives, no stomach upset. In this study, children allergic to gluten (a protein found in wheat) had evidence of autoimmunity to cells in the thyroid and pancreas. Would this not lead to strong evidence for every patient with suspected hypothyroidism to have a trial of wheat elimination?

J Pediatr 2000;137:263-265 Patients with celiac disease have high levels of diabetes- and thyroid-related autoantibodies that “disappear” when the patients are placed on a gluten-free diet. The finding confirms the high prevalence of organ-specific autoantibodies in patients with celiac disease, and supports the theory that these antibodies are gluten-dependent, Dr. Alessandro Ventura, of the Universita di Trieste, Italy, and colleagues say in the August issue of the Journal of Pediatrics. The investigators tested 90 children with celiac disease for serum antibodies to islet cells, glutamic acid decarboxylase, insulin, and thyroperoxidase. The overall prevalence of diabetes- and thyroid-related autoantibodies was 11.1% and 14.4%, respectively.

Role of INF-gamma in promoting Th 1 responses in coeliac disease – (02-26-01)

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Role of INF-gamma in promoting Th 1 responses in coeliac disease

Coeliac disease is an allergy to gluten, primarily found in wheat. Coeliac disease is the result of a Th1 cytokine response–the branch of the immune system that is responsible for the “attack” mode towards invaders. By continuing to eat wheat that the body is allergic to, a patient with coeliac disease will perputuate this unbalanced reaction of the immune system; potentially effecting other systems in the body. Coeliac disease has been linked to Alzheimers, diminished bone mass and neurological problems (ataxia) among others. Avoiding gluten is a foundation in any functional medicine approach to health.

Gut — Abstracts: Monteleone et al. 48 (3): 425

Read entire article here

Classic Presentation of Celiac Disease Is Not Most Common – (11-08-01)

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Classic Presentation of Celiac Disease Is Not Most Common

This interesting portion of this article is that one third of patients in this study were originally identified as having irritable bowel syndrome. Most patients had seen three physicians before the correct diagnosis was made. Celiac disease is an allergy to one of the proteins found in certain grains, principally wheat. The take home message here is that any patient with IBS (and any GI complaints in general) needs to be put on an elimination diet devoid of the common allergens wheat, dairy, corn and soy.

66th Annual Scientific Meeting of the American College of Gastroenterology The classic presentation of celiac disease, severe malabsorption symptoms beginning in childhood, is actually not the most common presentation, according to study findings presented Monday at the 66th Annual Scientific Meeting of the American College of Gastroenterology. Dr. Robert D. Zipser, from Harbor-UCLA Medical Center in Torrance, California, and colleagues surveyed 1032 patients with biopsy-proven celiac disease to determine the most common presentations. The median age at diagnosis was 46 years and 14 patients were over 80 years when first diagnosed, the investigators note. Only 12% of patients were diagnosed before 10 years of age. Most patients had normal weights at diagnosis. While diarrhea was a common initial symptom, a few patients presented with constipation. Anemia, fatigue, flatus, bloating, and abdominal pain were also frequent presentations. Five percent of patients were asymptomatic. Most patients saw three physicians prior to being diagnosed. More than a third of patients were initially diagnosed with irritable bowel syndrome, the investigators report. The median time from initial presentation to biopsy-proven diagnosis was 1 year. However, 19% of patients had symptoms for more than 10 years before being diagnosed. “The goal of the study was to help physicians recognize celiac disease,” says Dr. Zipser. “Physicians often think of it as a rare malabsorptive disease limited to childhood,” he said. “However, the current findings indicate that celiac disease usually presents in adulthood with symptoms mimicking those of irritable bowel syndrome,” he added. While the findings indicate that adult onset is common, Dr. Zipser pointed out that for a small minority of patients the disease was probably missed during childhood. “Many symptoms which are typical of the childhood form are relatively uncommon in the adult form,” Dr. Zipser stated. For example, “weight loss is common in the childhood form, but uncommon in the adult form,” he noted. In fact, he added “some of the patients were actually obese,” he added. While all of the patients in the current study underwent small bowel biopsy, Dr. Zipser noted that it is now quite easy to diagnose celiac disease. “A simple blood test can determine whether antibodies to wheat products are being made,” he explained.

Celiac Disease Overlooked as Cause of Iron-Deficiency Anemia – (02-19-01)

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Celiac Disease Overlooked as Cause of Iron-Deficiency Anemia

Celiac disease (gluten insensitivity; an allergy to certain proteins in wheat, barley and rye) does occur at a surprisingly high percentage in our population (one in 100 to 300, depending upon whom you ask…), and anemia is only a small portion of the potential deleterious effects; Alzheimers, autoimmune diseases, dental caries and osteoporosis are but a few others on the list. Remember that food allergies, no matter the type, can upregulate the immune system and lead to excessive inflammation. One chaep, easy way to begin to cut down on some of your food allergies is to add betaine HCL (stomach acid) to your meals–the better we break down proteins to amino acids, the less likely those proteins are to invoke an allergic response.

Br J Haematol 2000;111:898-901 Especially in menstruating women, celiac disease appears to be underinvestigated as a potential cause of iron-deficiency anemia. Dr. D. J. Unsworth of Southmead Hospital in Bristol, UK, and colleagues identified 483 blood samples from prospective blood donors who met study criteria for anemia (hemoglobin <11 g/dL for women, <13.5 g/dL for men in order to recruit enough men). Of the donors, 28 women (26 premenopausal) and 4 men tested positive for IgA anti-endomysial antibodies and were asked to undergo further followup for celiac disease. Of the 25 subjects who underwent endoscopic small intestinal biopsy, 22 “had histological changes compatible with celiac disease,” the researchers write. Twenty-one of these were women, and Dr. Unsworth’s team notes that none of the women had been previously investigated for the possibility of celiac disease. The research team reports that their screening of anemic adults for celiac disease resulted in a detection rate of over 6%, compared with 0% detection of celiac disease using EDTA blood samples from 250 nonanemic blood donors. “Celiac disease serology is easy, cheap and reliable,” the authors write. “We recommend that all cases of anemia of uncertain cause, including all women with anemia ascribed to menstrual blood loss or poor diet, be checked for celiac disease-associated autoantibodies.”