Celiac Disease | Vanguard Neurologist

Our Site Network	Dr. Perlmutter »	Vanguard Neurologist »	Perlmutter Health Center »

Mayo Clinic Discovers Potential Link Between Celiac Disease And Cognitive Decline

September 16th, 2010

From

Mayo Clinic researchers have uncovered a new link between celiac disease, a digestive condition triggered by consumption of gluten, and dementia or other forms of cognitive decline. The investigators’ case series analysis — an examination of medical histories of a group of patients with a common problem — of 13 patients will be published in the October issue of Archives of Neurology

There has been very little known about this connection between celiac disease and cognitive decline until now,” says Keith Josephs, M.D., Mayo Clinic neurologist and study investigator. “This is the largest case series to date of patients demonstrating cognitive decline within two years of the onset of celiac disease symptom onset or worsening.”

Says Joseph Murray, M.D., Mayo Clinic gastroenterologist and study investigator, “There has been a fair amount written before about celiac disease and neurological issues like peripheral neuropathy (nerve problems causing numbness or pain) or balance problems, but this degree of brain problem — the cognitive decline we’ve found here — has not been recognized before. I was not expecting there would be so many celiac disease patients with cognitive decline.”

The next step in the research will be to investigate the measure and nature of the connection between the two conditions.

“It’s possible it’s a chance connection, but given the temporal link between the celiac symptoms starting or worsening and the cognitive decline within a two-year time span, especially the simultaneous occurrence in five patients, this is unlikely a chance connection,” says Dr. Josephs. “Also, these patients are relatively young to have dementia.”

Theories to explain the connection between celiac disease and cognitive decline include the following, according to Dr. Murray:

Nutritional deficiency

Inflammatory cytokines — chemical messengers of inflammation that could contribute to problems in the brain

An immune attack on the brain that may occur in some patients with celiac disease

The cognitive decline that occurred in three of the celiac disease patients studied, according to Dr. Josephs, is relatively unique in its reversal in two of the patients and stabilization in one patient. Typically, cognitive decline continues to worsen, he says. “This is key that we may have discovered a reversible form of cognitive impairment,” he says.

William Hu, M.D., Ph.D., Mayo Clinic neurology resident and study investigator, says that the reversal or stabilization of the cognitive symptoms in some patients when they underwent gluten withdrawal also argues against chance as an explanation of the link between celiac disease and cognitive decline.

Currently, the investigators do not know which celiac disease patients are at risk for cognitive decline; this deserves future investigation, says Dr. Hu.

Dr. Murray suggests that recognizing and treating celiac disease early will likely prevent most consequences of the disease, including symptoms in the gut or the brain. For celiac disease patients who have already developed cognitive decline, closely following a gluten-free diet may result in some symptom improvement, he says. For those with cognitive decline without a confirmed diagnosis of celiac disease, he does not recommend a gluten-free diet, however.

Physicians can play an important role in keeping alert to a potential celiac disease and cognitive decline connection, says Dr. Hu.

“For patients who come in with atypical forms of dementia, we need to consider checking for celiac disease, especially if the patients have diarrhea, weight loss or a younger age of onset — under age 70,” he says.

To conduct this case series analysis, the researchers identified 13 Mayo Clinic patients with documented cognitive impairment within two years of onset of symptoms or severe exacerbation of adult celiac disease. All celiac disease had been confirmed by small-bowel biopsy, and any patients for whom an alternate cause of cognitive decline could be identified were excluded from the analysis. Patients included five women and eight men, with a median onset of cognitive decline at age 64 that coincided with onset or worsening of symptoms of diarrhea, the presence of excess fat in the stools and abdominal cramping in five patients. The most common reasons for seeking medical help were amnesia, confusion and personality changes. The average score on the Short Test of Mental Status among the 13 patients was 28 out of 38 possible total, indicating moderate cognitive impairment. Ten patients experienced loss of coordination and four experienced symptoms of peripheral neuropathy. Four patients demonstrated deficiency in folate, vitamin B-12, vitamin E or a combination of these deficiencies, although supplementation did not improve the patients’ cognitive decline. Three patients’ cognitive decline either improved or stabilized when they completely withdrew from gluten consumption. A brain autopsy or biopsy was completed in five patients, and there was no evidence of Alzheimer’s disease or any other well-known causes for dementia.

Gluten brain, gluten headache, gluten adhd, gluten cognitive, gluten perlmutter

The Overlooked Diagnosis of Celiac Disease

December 16th, 2009

From NYTimes.com:

It took three decades to figure out what was making Donna Sawka so sick. Her symptoms — bloating, chronic diarrhea and weight loss — began early in childhood, and they only became worse as she aged.
Nine years ago, after developing severe anemia, a specialist told Ms. Sawka that she had celiac disease. The digestive disorder causes damage to the small intestine when gluten, a protein found in wheat, barley and rye, is ingested. People with the disease need to follow a strict gluten-free diet for the rest of their lives to avoid serious complications like osteoporosis and lymphoma, an immune system cancer.
Ms. Sawka, 48, of Fairless Hills, Pa., said she “was overwhelmed” upon learning she had the disease.
“I kept thinking about everything I wouldn’t be able to eat,” she went on. “I couldn’t even receive communion at church.”
Ms. Sawka’s reaction is a familiar one at the support group she attends. It takes the average patient 10 years to receive a diagnosis. And according to specialists, they are the lucky ones. Studies show that 3 million Americans, or 1 in every 133 people, have celiac disease. But 95 percent of them have yet to learn they have it, according to the National Institutes of Health.
“The entire disease and all of its manifestations are incredibly underdiagnosed,” said Dr. Charles Bongiorno, the chief of the division of gastroenterology and hepatology at the University of Medicine and Dentistry of New Jersey. “Patients often have it for a decade or two before they are diagnosed.”
Celiac disease is often difficult to detect because the symptoms vary so widely from person to person. Ten years ago, the medical community thought it was a rare disorder that affected only 1 in every 10,000 people, primarily children who had digestive problems and failure to thrive.
But physicians now know that the disease is much more common. Most patients never experience the so-called classic symptoms: bloating, chronic diarrhea and stomach upset. Instead, the signs are often as nebulous as anemia, infertility and osteoporosis.
“It’s a problem,” said Dr. Ritu Verma, section chief of gastroenterology, hepatology and nutrition and director of the Children’s Celiac Center at the Children’s Hospital of Philadelphia. “The majority of patients do not have the traditional signs and symptoms. If someone’s only presenting symptom is anemia, physicians will think of a hundred other things before they think of celiac disease.”
As a result, the condition is also commonly mistaken for other ailments. Ms. Sawka, for one, was told she had everything from irritable bowel syndrome to lupus to an allergic reaction from a spider bite before celiac disease was confirmed.
Part of the problem is also a lack of education among physicians, particularly internists. According to Dr. Bongiorno, most primary care physicians are simply unaware of new research that shows the disease is common and can manifest itself in unusual ways.
“They think it is an exotic malady,” he explained. “That persistent fallacy causes a less-than-appropriate effort to order the right blood tests and refer to gastroenterologists for care.”
In 2006, the National Institutes of Health started a campaign to raise awareness of the disease among both the general public and physicians. A goal was to increase rates of diagnosis because, unlike many ailments, there is a definitive way to stop celiac disease from progressing once it is recognized.
“The vast majority of cases experience a complete remission from symptoms once they are diagnosed and go on a gluten-free diet,” said Dr. Stefano Guandalini, director of the University of Chicago Celiac Disease Center. “So essentially, you have no disease. That is what makes it all the more important to be diagnosed.”
And there is no better time to be on a gluten-free diet. In 2008, 832 gluten-free products entered the market, nearly 6 times the number that debuted in 2003. Last year, gluten-free even emerged as a fad diet in the general population.
“The quantity and quality of these products is amazing,” said Dr. Alessio Fasano, the medical director of the Center for Celiac Research at the University of Maryland Medical Center.
Dr. Fasano said gluten-free products used to taste like cardboard but had significantly improved in recent years. “The only problem,” he said, “is that they cost five or six times more than their normal counterparts.”
Researchers are also beginning to experiment with drugs that may be able to block the immune response to gluten, much like a lactate pill. If the clinical trials are successful, individuals with celiac disease may be someday able to ingest small amounts of gluten.
Until then, the gluten-free diet is working for patients like Ms. Sawka. “I am perfect now,” she said after 35 years of feeling sick. “Every system in my body was in an uproar, and then everything just quieted down.”

Migraine and Celiac Disease

September 26th, 2009

From stanford.wellsphere.com:

Today is a marvelous day for people with celiac disease. And, it is especially wonderful for me since I suffered for more than 21 years with debilitating migraine headaches. I always thought that migraines just ran in my family. My dad and grandmother got them all the time and I just thought it was somewhat normal to always have a pain in the right side of my head….or at least I thought it was normal until the pain got so bad in college that I could hardly function. I was taking Intravenous prednisone daily (yes, a nurse came to my dorm room to administer it) and was nauseous and miserable all the time until that magical day that I was finally diagnosed with celiac disease.

Within six weeks of being on a a gluten-free diet, my headaches were gone. In my mind, it was truly a miracle. Since my diagnosis, I’ve told everyone I know who complains about migraine headaches to get tested for celiac disease. Today, I actually have scientific proof to send them that migraine headaches are an indicator of celiac disease! So here you go….published Turkish research about the connection between migraines and celiac!

The study is published in the September issue of the journal Cephalalgia and finds that children who experience migraine headaches have a greater risk of being diagnosed with celiac disease than children without headaches. I was first diagnosed with migraines when I was seven years old, so right in this age group!

Researchers from Baskent University Faculty of Medicine in Turkey studied 73 patients ranging in age from 6 to 17 who complained of migraine headaches and compared them with 147 healthy control patients. They found that 5.5% of the patients reporting migraine headaches tested positive for celiac disease, compared with only 0.6% of patients in the control group. Not all of the patients who received a positive blood test result underwent a biopsy to confirm the diagnosis, so the researchers are considering the findings a “reliable indicator of the presence of celiac disease.”

The researchers concluded that their findings of a higher prevalence of tTGA antibodies in migraine patients “suggests that an association between migraine and celiac disease might exist in the pediatric age group.”

Although the researchers note that significantly more research needs to be done, the study is a milestone for thousands of celiac patients who presented only with headache symptoms before receiving a diagnosis.

So…if you know someone who has routine migraine headaches, tell them to get tested for celiac disease! Send them to the National Foundation for Celiac Awareness and tell them to fill out a symptoms checklist and take it to their doctor! You never know…a simple blood test could change your life!

Gluten-Free Diet May Reverse Mental Decline in Patients / Celiac Disease Linked to Dementia

September 24th, 2009

From WebMD.com

Adults who develop the digestive condition known as celiac disease appear to be at increased risk for dementia, according to new research from the Mayo Clinic.

Celiac disease is a disorder caused by an immune reaction to eating gluten, found in some grains such as wheat, barely, and rye. Damage occurs to the inner lining of the small intestine. Classic symptoms include chronic diarrhea, weight loss, cramping, bloating, and gas.

About 10% of celiac patients have some neurologic symptoms, such as numbness and pain. But a link to dementia and other forms of mental decline has not been widely reported.

Mayo Clinic neurologist Keith A. Josephs, MD, MST, tells WebMD that he first made the connection when examining a patient suspected of having the fatal brain disorder Creutzfeldt-Jakob disease (CJD).

The patient did not have CJD, but he did have celiac disease. He also had rapid-onset dementia, which coincided with the onset of diarrhea and other well-recognized symptoms of the digestive disease.

“I wanted to find out if the dementia was related to the celiac disease,” Josephs says.

Gluten-Free Diet Reversed Dementia
Josephs and colleagues including William T. Hu, MD, PhD, examined the medical histories of 13 patients who showed evidence of serious mental declines within two years of developing symptoms of celiac disease.

The patients were between the ages of 45 and 79, and their average age was 64.

In five cases, celiac symptoms and mental decline occurred simultaneously. Two of the patients also recovered mental function when they followed gluten-free diets, and mental function stabilized in one patient.

Avoiding wheat and other gluten-containing grains is the main treatment for celiac disease.

“This is a big deal,” Josephs says. “It is almost unheard of to see a reversal in dementia or cognitive decline.”

The next step, he says, is to try and figure out the connection between celiac disease and mental deterioration. One theory is that the immune response to celiac disease attacks the brain. Another is that the disease causes inflammation within the brain, which triggers dementia.

Mayo clinic gastroenterologist and celiac disease expert Joseph Murray, MD, says he was surprised that the link was so strong.

“I was not expecting that there would be so many celiac disease patients with cognitive decline,” he said.

Celiac Often Misdiagnosed
Celiac disease is common, occurring in about one in 133 people, Murray says. But it is often misdiagnosed or missed altogether due to the vague nature of the symptoms.

The new findings give doctors an added reason to identify patients with celiac disease and to treat patients who have been diagnosed, the researchers conclude.

That means ruling out celiac disease in patients who have atypical forms of dementia and being watchful for mental decline in celiac patients.

Many gluten-free formulations lack essential nutrients

June 8th, 2009

From FoodNavigator.com:

Food manufacturers’ efforts to formulate gluten-free foods could leave celiacs’ diets short of essential nutrients, according to an article from Harvard Medical School.

Celiac disease is an autoimmune disorder with symptoms triggered by gluten, the protein in wheat, barley, rye and spelt. The only treatment currently available is to avoid gluten-containing foods and, as a result of increased diagnosis of the condition, combined with increased popularity of gluten-free diets for perceived health benefits, the market for gluten-free products has rocketed.

The Harvard Health Letter said that as food manufacturers have looked to profit from the trend, and learned to use xanthan and guar gums to replace gluten’s elasticity in gluten-free formulations, diets can end up lacking essential nutrients including fiber and B vitamins.

Improved texture

The problem is with increased palatability of gluten-free foods containing starch from rice, corn and potatoes – which contain relatively lower levels of fiber and nutrients – through the addition of gums. Powdery product consistency has been a common complaint regarding gluten-free foods and gums have helped to resolve the issue, but as people increasingly turn to products made with gluten substitutes, their diets could suffer, the letter said.

The concern was raised by Melinda Dennis, nutrition coordinator at the Beth Israel Deaconess Medical Center Celiac Center, who said that celiac patients should look to “unconventional but nutritionally well-rounded substitutes” for gluten-containing grains, like amaranth, buckwheat, teff, millet, quinoa and sorghum. She calls these the “super six” because of their high nutritional value.

Dennis added that another option for celiacs is to choose “celiac-friendly” cuisines, like Indian, Thai, Mexican and Ethiopian (which uses teff).

Why gluten-free?

The letter split those choosing gluten-free diets into three camps.

Firstly, it said that gluten-free food is becoming more popular partly because of increased awareness and diagnosis of celiac disease. Then it mentions a “gray area” of those who do not have celiac disease but who “seem to be unable to digest gluten properly”. Regarding this group, the letter said: “It’s hard to know what’s going on. Some people may be getting caught up in a food fad. But many others probably do have a real problem digesting gluten or perhaps the sugars in some of these grains.”

Finally, it mentions a third group who blame gluten for a wide range of medical problems.

“For example, there’s a fairly loud internet ‘buzz’ about autistic children improving once they’re on a gluten-free diet,” it said. “…But based on what’s currently known, it’s a big leap to attributing autism and other problems to gluten, and an even bigger one to prescribing gluten-free eating as a treatment.”

Market research organization Packaged Facts clearly sees the trend toward gluten-free formulations as more than a fad, estimating that sales of gluten-free products will reach $2.6bn by 2012.

In a recent report, it said that the gluten-free market has grown at an average annual rate of 28 percent since 2004, when it was valued at $580m, to reach $1.56bn last year.

While only 40,000 to 60,000 Americans are diagnosed as celiac, the federal government estimates that there could be as many as 3m who are undiagnosed – or just under one percent of the population.