Coeliac Disease and gluten sensitivity
Coeliac Disease:
Gluten is a protein found in wheat, and also in oats, barley and rye. In people with a genetic predisposition to Coeliac Disease, the immune system reacts badly to the gluten found in these cereals, creating damage in the small intestine.
Coeliac Disease is an autoimmune disease where the body forms antibodies to the gluten. The damage is caused to the villi, the small finger-like projections that line the intestine. The job of the villi is to increase the surface area available for the absorption of nutrients from digested food. In Coeliac Disease, the villi become inflamed by the immune attack and flatten off, reducing the surface area inside the intestine, causing unpleasant gastrointestinal symptoms such as stomach pain, gas/bloating, nausea and vomiting, diarrhoea and pale bowel motions.
The upshot of this is malabsorption, where the affected person cannot get enough nutrition from the food they eat, causing them to become malnourished.
Associated conditions are missed menstrual periods, miscarriage or infertility, birth defects like neural tube defects related to poor absorption of folic acid, failure to thrive in children due to malnutrition, mouth ulcers, osteoporosis (weakened bones) due to malabsorption of calcium and vitamin D, iron deficiency anaemia, severe skin rash, hair loss and weight loss.
Sometimes, people with Coeliac Disease may also have another autoimmune disease, which may include Thyroid Disease, Type 1 Diabetes, Lupus, Rheumatoid Arthritis, Sjogren’s Syndrome (dryness of the mouth and eyes and associated neurological issues), Addison’s Disease (adrenal insufficiency), and Sarcoidosis (inflamed nodules in lungs or lymph nodes)
Diagnosis is by a combination of medical history, physical examination, blood testing for antibodies associated with Coeliac Disease, and potentially for deficiencies that are associated with the condition. A biopsy of the small intestine may also be performed and is definitive.
Treatment of the condition is by way of a gluten free diet, which involves the complete avoidance of gluten in any foods or drink.
Non-Coeliac gluten intolerance:
Gluten sensitivity or intolerance is somewhat controversial compared to Coeliac Disease. It is thought to occur in the absence of Coeliac Disease and wheat allergy, where individuals develop symptoms that improve when gluten is removed from the diet. The symptoms are similar to those of Coeliac Disease.
Coeliac Disease, gluten sensitivity and multiple sclerosis:
Of interest to people with multiple sclerosis are the deficiencies associated with Coeliac Disease and non–coeliac gluten sensitivity including iron, Vitamin D and Vitamin B12 deficiencies, which could be feeding into MS symptomology. Coeliac Disease can cause symptoms which mimic MS. These include fatigue and weakness, muscle and joint pain, weight loss, depression, seizures, neuropathies (burning, tingling and numbness) and ataxia, which can cause gait abnormalities. This Canadian Journal of Gastroenterology article discusses the neurological manifestations of Coeliac Disease http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2661192/
This About Health article also discusses neurological aspects of gluten intolerances http://celiacdisease.about.com/od/CeliacNeuroSymptoms/a/Gluten-Neurological-Symptoms.htm
This 2011 study found an increased prevalence of Coeliac Disease in people with MS compared to the general population http://www.biomedcentral.com/content/pdf/1471-2377-11-31.pdf
This discussion of that study notes that even more of the patients examined had signs on investigation that pointed to borderline Coeliac type damage in the intestine http://surefoodsliving.com/2011/03/multiple-sclerosis-linked-to-celiac-disease-and-gluten-sensitivity/
Roger MacDougall who was probably the father of the paleo diet, claimed to have put his severely advanced MS into remission by following what he called a ‘hunter gatherer’ diet, including a strict gluten free component. His story can be read here http://www.direct-ms.org/rogermcdougall.html
Other ‘MS diets’ since then have often emphasised a gluten free component, based on the notion that in evolutionary terms, cereals are a recent addition to the human diet, and as a species we are not adapted to this protein. Proponents of a gluten free way of life also point to selective breeding and processing practices which has radically increased the gluten component in individual foods, and the addition of gluten to a wider range of foods.
Anyone with MS who is seeking to optimise their health in all dimensions, can consider being examined for Coeliac Disease and/or gluten sensitivity. Those who wish to take a precautionary approach may also consider either trialing a gluten excluding diet for a sufficiently long time frame to see if they feel better in any way, or a full gluten free diet as part of a dietary strategy to maximise their long term health outcomes.
Links:
Coeliac Disease Australia Website http://www.coeliac.org.au/coeliac-disease/
Coeliac Disease Australia page on Non – Coeliac gluten sensitivity http://www.coeliac.org.au/gluten-sensitivity/
Haemochromatosis
Coeliac Disease:
Gluten is a protein found in wheat, and also in oats, barley and rye. In people with a genetic predisposition to Coeliac Disease, the immune system reacts badly to the gluten found in these cereals, creating damage in the small intestine.
Coeliac Disease is an autoimmune disease where the body forms antibodies to the gluten. The damage is caused to the villi, the small finger-like projections that line the intestine. The job of the villi is to increase the surface area available for the absorption of nutrients from digested food. In Coeliac Disease, the villi become inflamed by the immune attack and flatten off, reducing the surface area inside the intestine, causing unpleasant gastrointestinal symptoms such as stomach pain, gas/bloating, nausea and vomiting, diarrhoea and pale bowel motions.
The upshot of this is malabsorption, where the affected person cannot get enough nutrition from the food they eat, causing them to become malnourished.
Associated conditions are missed menstrual periods, miscarriage or infertility, birth defects like neural tube defects related to poor absorption of folic acid, failure to thrive in children due to malnutrition, mouth ulcers, osteoporosis (weakened bones) due to malabsorption of calcium and vitamin D, iron deficiency anaemia, severe skin rash, hair loss and weight loss.
Sometimes, people with Coeliac Disease may also have another autoimmune disease, which may include Thyroid Disease, Type 1 Diabetes, Lupus, Rheumatoid Arthritis, Sjogren’s Syndrome (dryness of the mouth and eyes and associated neurological issues), Addison’s Disease (adrenal insufficiency), and Sarcoidosis (inflamed nodules in lungs or lymph nodes)
Diagnosis is by a combination of medical history, physical examination, blood testing for antibodies associated with Coeliac Disease, and potentially for deficiencies that are associated with the condition. A biopsy of the small intestine may also be performed and is definitive.
Treatment of the condition is by way of a gluten free diet, which involves the complete avoidance of gluten in any foods or drink.
Non-Coeliac gluten intolerance:
Gluten sensitivity or intolerance is somewhat controversial compared to Coeliac Disease. It is thought to occur in the absence of Coeliac Disease and wheat allergy, where individuals develop symptoms that improve when gluten is removed from the diet. The symptoms are similar to those of Coeliac Disease.
Coeliac Disease, gluten sensitivity and multiple sclerosis:
Of interest to people with multiple sclerosis are the deficiencies associated with Coeliac Disease and non–coeliac gluten sensitivity including iron, Vitamin D and Vitamin B12 deficiencies, which could be feeding into MS symptomology. Coeliac Disease can cause symptoms which mimic MS. These include fatigue and weakness, muscle and joint pain, weight loss, depression, seizures, neuropathies (burning, tingling and numbness) and ataxia, which can cause gait abnormalities. This Canadian Journal of Gastroenterology article discusses the neurological manifestations of Coeliac Disease http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2661192/
This About Health article also discusses neurological aspects of gluten intolerances http://celiacdisease.about.com/od/CeliacNeuroSymptoms/a/Gluten-Neurological-Symptoms.htm
This 2011 study found an increased prevalence of Coeliac Disease in people with MS compared to the general population http://www.biomedcentral.com/content/pdf/1471-2377-11-31.pdf
This discussion of that study notes that even more of the patients examined had signs on investigation that pointed to borderline Coeliac type damage in the intestine http://surefoodsliving.com/2011/03/multiple-sclerosis-linked-to-celiac-disease-and-gluten-sensitivity/
Roger MacDougall who was probably the father of the paleo diet, claimed to have put his severely advanced MS into remission by following what he called a ‘hunter gatherer’ diet, including a strict gluten free component. His story can be read here http://www.direct-ms.org/rogermcdougall.html
Other ‘MS diets’ since then have often emphasised a gluten free component, based on the notion that in evolutionary terms, cereals are a recent addition to the human diet, and as a species we are not adapted to this protein. Proponents of a gluten free way of life also point to selective breeding and processing practices which has radically increased the gluten component in individual foods, and the addition of gluten to a wider range of foods.
Anyone with MS who is seeking to optimise their health in all dimensions, can consider being examined for Coeliac Disease and/or gluten sensitivity. Those who wish to take a precautionary approach may also consider either trialing a gluten excluding diet for a sufficiently long time frame to see if they feel better in any way, or a full gluten free diet as part of a dietary strategy to maximise their long term health outcomes.
Links:
Coeliac Disease Australia Website http://www.coeliac.org.au/coeliac-disease/
Coeliac Disease Australia page on Non – Coeliac gluten sensitivity http://www.coeliac.org.au/gluten-sensitivity/
Haemochromatosis