For a TV segment with me on Gluten Sensitivity on Let’s Talk Live DC, click here.
Unless you’re living in a bubble, you’ve heard about plenty people who do not have Celiac disease, and yet report all sorts of positive health improvements a gluten-free diet. While for some it is obviously a just a fad, we’ll discuss what the research is on non-Celiac gluten sensitivity, and groups of people that seem to be most affected. The main conditions linked to both Celiac disease and non-Celiac gluten sensitivity are IBS, neurological issues, autoimmune conditions, such as autoimmune thyroid disease or Type 1 diabetes, and schizophrenia. I absolutely believe that all people should get tested for Celiac disease before going gluten-free, simply because the diet is a lifelong commitment, and ideally, that’s a really long time. And I’ve definitely found that people with a firm diagnosis are usually more compliant with the diet.
I can’t count the number of times people with gut issues report that a gluten-free diet helps their symptoms, despite testing negative for Celiac disease. Research is starting to back them up. It’s well-established that Celiac disease is 4-5 times more common in people with IBS than the general population. And yet there are also a group of people without Celiac disease that respond favorably to a gluten-free diet. It is most commonly seen in people with the HLA geneotype DQ2, which most people with CD have. So is this a pre-Celiac condition? A similar condition? We’re really not sure. The American College of Gastroenterology published a 2009 article on the “No Man’s Land of Gluten Sensitivity”[i] and states that “even in the absence of fully developed celiac disease, gluten can induce symptoms similar to FBD (Functional Bowel Disorders). Even more striking is the estimate that for every person with CD, there are at least six or seven people who are gluten sensitive.”[ii] Also, a study in Australia in January 2011 looked at people with IBS WITHOUT celiac disease and gave them either gluten or a placebo. There were statistically significant changes in overall symptoms, abdominal pain, bloating, and fatigue in just 6 weeks[iii]. Although this is a small study, it was the first of its kind.
Neuropathy is a general term for conditions involving nerve cells. It includes everything from ataxia, or lack of muscle coordination, peripheral neuropathy, or numbness and/or tingling in hands and feet, to headaches and more. Neuropathy is very common in people with Celiac disease even when they are on a gluten-free diet, possibly as high as 22%[iv] . However, compared to healthy people, a much higher percentage of people who have neuropathies WITHOUT Celiac test positive for AGA antibodies (an old screening test used for Celiac). Our typical celiac tests look at tissue transglutaminase 2, while it seems like people with neuropathies most often have tissue transglutaminase 6. Almost all of these people have one of the HLA typings linked to Celiac (DQ2 or DQ8). When gluten is removed, these markers disappear. Only a few research studies have been done on removing gluten in the diet, but there are indications of improvements. And yet this is certainly an interesting area of research which we will hopefully learn much more about in future years! Although this study is very dense, it gives a nice overview of the connection between gluten and neuropathy[v]
There has been an established link between schizophrenia and Celiac since the ‘60s, and it’s profound. As one study puts it, “a drastic reduction, if not full remission, of schizophrenic symptoms after initiation of gluten withdrawal has been noted in a variety of studies. However, this occurs only in a subset of schizophrenic patients.”[vi] Although there is still debate, non-celiacs with schizophrenia have higher rates of AGA antibodies, and the rate of response to a gluten free diet seems higher than the rate of people with CD. Considering how debilitating the disease is, that’s astounding!
Type 1 diabetes and autoimmune thyroid disease[vii]are both linked to Celiac disease, and yet animal models show a more generalized sensitivity to gluten. Though the word gluten was not used, a study of Type 1 diabetics without CD showed less immune dysfunction on a wheat-free diet[viii]. While this is less concrete, it will be fascinating to see what research has to show over the next few years.
At this point, there are no widely accepted, definitive, research-based tests for gluten sensitivity, although I mentioned several suggestive tests. This is why “diagnosis” for many people it is simply a matter of trial and error. I would not recommend Enterolab testing because they have published no research in the decade or more they have been in practice. There is a new lab out called Cyrex (beginning in January 2011 which is promoted by Dr. Tom O’Brien, who has been a leading celiac researcher for years).[ix] As of yet, their test are not validated in scientific research, but this is a very promising test to watch.
As a final note, the strength of the link between gluten and these conditions is variable, and yet, so many people stand to potentially benefit. This is also does not mean that everyone should go gluten-free. And this is no longer a “fringe” view. Links to all of the referenced studies are below, and all are from peer reviewed major journals from the last few years (and these are just some of the studies out there). It is quite a controversial topic, and we all have a lot to learn. Personally, I am delighted that the medical community is now recognizing that gluten intolerance is true a medical condition, and look forward to seeing our knowledge continue to evolve.
[i] Verdu EF, Armstrong D, Murray JA. Between celiac disease and irritable bowel syndrome: the “no man’s land” of gluten sensitivity. Am J Gastroenterol. 2009 Jun ;104(6):1587-94. http://www.ncbi.nlm.nih.gov/pubmed/19455131
[ii] Bizzaro N, Tozzoli R, Villalta D, Fabris M, Tonutti E. Cutting-Edge Issues in Celiac Disease and in Gluten Intolerance. Clin Rev Allergy Immunol. 2010 Dec 23;1559-0267(1559-0267) http://www.ncbi.nlm.nih.gov/sites/entrez?term=21181303&db=pubmed
[iii] Biesiekierski JR, Newnham ED, Irving PM, Barrett JS, Haines M, Doecke JD, Shepherd SJ, Muir JG, Gibson PR. Gluten Causes Gastrointestinal Symptoms in Subjects Without Celiac Disease: A Double-Blind Randomized Placebo-Controlled Trial. Am J Gastroenterol. 2011 Jan 11;1572-0241(1572-0241)
[iv] Briani C, Zara G, Alaedini A, Grassivaro F, Ruggero S, Toffanin E, Albergoni MP, Luca M, Giometto B, Ermani M, De F, Lazzari A, D’Odorico L, Battistin . Neurological complications of celiac disease and autoimmune mechanisms: a prospective study. J Neuroimmunol. 2008 Mar ;195(1-2):171-5.
[v] Hadjivassiliou M, Sanders DS, Grünewald RA, Woodroofe N, Boscolo S, Aeschlimann D. Gluten sensitivity: from gut to brain. Lancet Neurol. 2010 Mar ;9(3):318-30.
[vi] Kalaydjian AE, Eaton W, Cascella N, Fasano A. The gluten connection: the association between schizophrenia and celiac disease. Acta Psychiatr Scand. 2006 Feb ;113(2):82-90.
[vii] Harris, C, Kaplan G. http://todaysdietitian.com/newarchives/110310p52.shtml
[viii] Mojibian M, Chakir H, Lefebvre DE, Crookshank JA, Sonier B, Keely E, Scott FW. Diabetes-specific HLA-DR-restricted proinflammatory T-cell response to wheat polypeptides in tissue transglutaminase antibody-negative patients with type 1 diabetes. Diabetes. 2009 Aug ;58(8):1789-96.
Links are at the bottom of the newsletter
Meeting Topic: “Healthy Gluten-Free Eating” (and tasting samples!)
Speaker: Cheryl Harris, MPH, RD
Location: Bethesda Central Library (Maryland)
7400 Arlington Road, Bethesda, MD 20814
Also, there are now monthly gluten-free potluck and events.
Harris Whole Health offers individual sessions, family sessions and group classes to help people eat healthier and feel better! Cheryl works with people to feel and look their best with a range of specialties, including Celiac Disease, food allergies, pregnancy, breastfeeding, vegetarian and vegan diets, preventing diseases and “whole foods” eating. Let’s get you on your way to achieving your goals. For an appointment with Cheryl Harris, Registered Dietitian and Nutritionist, please click here, email or call 571-271-8742.