Unmasking Celiac Disease

Celiac disease has been linked to an increasing number of neurological issues. It has also been shown to potentially shorten lifespan if left untreated. Readers requested more information on gluten sensitivity, and we asked Dr. Albert Robbins to share his advice.

Once seen in one in 10,000 people, some level of celiac disease (CD) is now seen in one in 133. The condition can directly affect the neurological conditions of interest to Latitudes readers, and often goes undetected.

Gluten is a protein present in certain grains such as wheat, rye and barley. These proteins can be a valuable source of nutrition, or they can trigger an autoimmune response known as celiac disease. In an autoimmune reaction, the immune system attacks and harms tissues in one’s own body.

Research suggests that the disorder surfaces when a person has these three conditions:

1. a genetic susceptibility;
2. a “leaky gut” or permeable intestinal wall, and;
3. is exposed to gluten.

With CD, the villi (little fingerlike structures) in the small intestine become inflamed and cannot complete important processes they are responsible for: breaking food down and then moving nutrients across the cell wall to the blood stream.

When absorption is disrupted, symptoms such as those below can occur. Physicians sometimes miss the CD diagnosis because classic gastrointestinal symptoms are not always present.

Clinical features or symptoms

New research shows that major clinical features of celiac disease can include a combination of some of the following possible symptoms:

• Gastrointestinal symptoms like diarrhea, intestinal gas, bloating, constipation;
• Crohn’s disease and associated conditions;
• Joint pain, anemia, osteoporosis;
• Recurrent oral ulcers/canker sores, and sores at the corners of the mouth; glossitis (inflammation or infection of the tongue);
• Generalized symptoms of weakness, malaise, and weight loss;
• Dermatitis herpetiformis (a skin blistering autoimmune disorder);
• Vasculitis (inflammation of blood vessels);
• Vitamin K or iron deficiency;
• Malabsorption syndrome;
• Nausea and vomiting in severely gluten-sensitive individuals;
• Numbness in the hands and feet;
• Vague neurological disorders and migraine headache, learning disabilities, depression, psychosis, schizophrenia, epilepsy, cognitive decline migraine headache, and ADHD may be present due to gluten’s effect on neuron opiate receptors in the brain;
• Calcium, vitamin D, folic acid, and selective IgA deficiencies are often seen.

An association between celiac disease and asthma, eczema, and urticaria/hives has been well established. In medical studies, positive skin tests to foods and environmental allergens were more common in celiac patients than in controls.

Celiac disease can also be associated with other autoimmune disorders including Addison’s disease, Graves disease, type 1 diabetes, myasthenia gravis, scleroderma, Sjogren’s syndrome, atrophic gastritis and pancreatic insufficiency.

Treatment of CD

A gluten-free diet can often dramatically impact symptom control. Many patients with celiac disease also have lactose intolerance and/or cow’s milk allergy. They should avoid all dairy products until all intestinal symptoms have improved on a gluten-free diet. Some signs of improvement should be evident within a few weeks on a gluten (and casein-free) diet. The most common reason for treatment failure is incomplete removal of gluten.

While the diet is quite challenging, many excellent cookbooks are now available, and some restaurants are beginning to specify gluten-free items on their menus.

Nutrient supplementation with B₁₂ and folic acid injections, and calcium and vitamin C through I.V. therapy, can be helpful especially in the beginning of treatment. Vitamin D should be supplemented if levels are low, which is common. Your physician should recommend hypoallergenic nutritional supplementation available through a compounding pharmacy.

Gluten or wheat can cause symptoms that mimic irritable bowel syndrome in otherwise healthy people. Anyone with symptoms of diarrhea, colicky abdominal pain, and/or intestinal gas may benefit from a trial of a gluten-free diet.

Patients with autism are routinely placed on allergy elimination diets as a trial to see if symptoms improve. On a combined milk-free (casein-free) and gluten-free diet, many are helped.

Comprehensive testing:

Most important:

1. HLA Typing for celiac disease (a genetic screening test)
2. Antigliadin antibody test
3. Allergy skin testing for wheat, milk and other food allergens

Helpful in ruling out issues that may be related to CD-type symptoms

1. Total IgG, IgM, IgA, IgE blood test
2. Testing for antiendomesial antibodies
3. Blood testing for casein, milk, wheat, and gluten antibodies
4. A comprehensive stool study for leaky gut syndrome — Great Plains Laboratory or Geneva Labs;
5. Candida antibodies (IgE, IgA, IgG and IgM) — Quest and Allermetrix Labs
6. Blood nutrient analysis — Spectracell Labs

Failing to follow a gluten-free diet when living with CD can not only negatively affect the quality of life but the length of life itself. Given the increasing number of people with this condition, readers are encouraged to consider whether they or their loved ones might benefit from a trial of an appropriate diet, or diagnostic testing and nutritional support.