Celiac Disease, Gluten Sensitivity and Autoimmune Disease

Celiac disease is a genetic autoimmune disorder which creates damage to the small intestine when the protein gluten, found primarily in wheat, barley and rye, is eaten.  Untreated, the damage leads to destruction of the intestinal villi which normally absorb the nutrients from food we eat.   Symptoms vary from person to person and may include:

     *unexplained iron-deficiency anemia
     *fatigue, weakness or lack of energy
     *delayed growth or onset of puberty
     *bone or joint pain
     *arthritis
     *bone loss or osteoporosis
     *depression, anxiety, behavior changes
     *tingling numbness in the hands and feet
     *seizures
     *fertility problems
     *canker sores inside the mouth
     *dental enamel defects
     *an itchy skin rash called dermatitis herpeiformis
     *recurring digestive discomfort / problems
     *epilepsy
     *dementia
     *schizophrenia [1]  



The symptoms of the disease may vary over the course of a lifetime, and can be silent and without noticeable symptoms during the teenage years.  Overall, celiac disease may be clinically silent in a third of patients.[2]   Moreover, about half of celiac patients do not have the typical symptoms doctors expect, or are incorrectly diagnosed. [3]  Since the treatment for celiac disease is abstention from gluten, the delay in diagnosis may lead to further complications from continued destruction of the intestinal villi, and consequent malnutrition.  Long term risks of untreated celiac disease include osteoporosis, anemia, liver disease, infertility and intestinal cancers. [4]  It is not surprising that a recent Mayo clinic study found that patients with undiagnosed celiac disease were nearly four times as likely to die during the 45 year follow up, than the patients who did not have celiac disease.[5]

There also is a relationship between celiac disease and the development of other autoimmune diseases, including:

     *type 1 diabetes
     *autoimmune thyroid disease
     *rheumatoid arthritis
     *sjogren's disease
     *addison's disease
     *autoimmune liver disease
     *scleroderma
     *multiple sclerosis
     *systemic lupus erythematosus [6]



In recent years, scientists have been studying the relationship between celiac disease and co-occurring autoimmune diseases to find out if there is a causal relationship, or a common factor involved in the diseases.   They have found patients with celiac disease, type 1 diabetes, multiple sclerosis, rheumatoid arthritis and inflammatory bowel disease all have an abnormal amount of permeability in their small intestine.  This permeability is thought to relate to a molecule secreted by the intestine, zonulin, that regulates the passage of fluid, large molecules and immune cells between body compartments.  In patients with celiac disease and some other autoimmune diseases, high levels of zonulin have increased the permeability of the small intestine.  In patients with celiac disease, the increase in zonulin secretion is due to the exposure to gluten. [7]  Alba Therapeutics is currently conducting trials of a zonulin inhibitor, Larazotide, as a treatment for celiac disease, and recently received approval from the U.S. Food and Drug Administration to expand studies to other autoimmune diseases, including Type 1 diabetes and Crohn's Disease.[8]  In addition, a long term study is focusing on whether restricting gluten from an infant's diet before age one in high risk individuals may decrease the chances of developing celiac disease.  Preliminary findings suggest the dietary restriction reduces by fourfold the likelihood that celiac disease will develop, however, scientists will have to follow the 700 subjects in the study for decades to determine whether this approach can stop celiac from ever occurring.[9]

In addition, scientists are looking at whether celiac patients who are following a gluten free diet receive relief from other autoimmune conditions.  In the case of autoimmune thyroid disease and type 1 diabetes, some studies have shown the gluten free diet has lowered the number of antibodies against thyroid and pancreatic tissue, respectively. [10]  There is not consensus yet on whether celiac disease causes other autoimmune diseases, although the discovery of the role of zonulin looks promising.  At the very least, doctors are beginning to realize that high risk groups (ie. those who have autoimmune disease) should be screened for celiac disease.[11]



Testing and Diagnosis


Eating gluten regularly prior to being diagnosed will insure you have antibodies in your blood to be measured.  Your doctor may order a blood test to measure the level of anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA), or other blood tests if these come back negative and celiac disease is suspected. [12]  Upon a positive blood test, an intestinal biopsy is conducted to assess damage to the intestinal villi.  If the damage exists, the diagnosis of celiac disease is confirmed.[13]

A negative blood test does not necessarily mean a patient does not have celiac disease.  Most of the sensitive blood tests measure IgA antibodies, which a certain percentage of the population can not make because they are IgA deficient.  In addition, some patients have less damage in their small intestine and the blood tests will not detect it.  Finally, a patient who is not eating very much gluten can have a negative blood test and still have active celiac disease. [14]

Some doctors believe that gluten sensitive individuals are already malnourished by the time there is visible damage to the small intestine, increasing the risk of developing anemia, osteoporosis, intestinal cancers and other autoiummune diseases if the patient continues eating gluten. [15]  Enterolab offers a more sensitive test that will detect celiac disease and gluten sensitivity, as well as dairy sensitivity.  This testing can be done with or without a doctor's order, although you may be able to obtain reimbursement from your insurance with a doctor's order.  For additional information, contact:

Enterolab
10875 Plano Rd., Suite 123
Dallas, TX 75238
972.686.6869

In addition, your doctor may order a gliadin IgG blood test, usually as part of a celiac screen blood test, or through a specialty lab such as ImmunoLabs or Great Plains Laboratory.

Finally, after a diagnosis of celiac disease or gluten sensitivity, tell your family members so they may be tested as well.



Recommended Reading:

Healthier Without Wheat: A New Understanding of Wheat Allergies, Celiac Disease, and Non-Celiac Gluten Intolerance.

References:

1.  National Digestive Diseases Information Clearinghouse, Celiac Disease Foundation,
2.  Robert C. Dahl, M.D., Presentation at the 23rd Annual CSA Conference, September 2000.
3.  Ibid.
4.  National Digestive Diseases Information Clearinghouse.
5.  Mayo Clinic News, June, 2009.
6.  National Digestive Diseases Information Clearinghouse,  Gluten Intolerance Group of North America,  Alessio Fasano, Surprises from Celiac Disease, Study of a potentially fatal food-triggered disease has uncovered a process that may contribute to many autoimmune disorders, Scientific American, August 2009.
7.  Fasano at 37.
8.  Fasano at 39.
9.  Ibid.
10.  Pekka Collin et. al, Endocrinological Disorders and Celiac Disease, Endocrine Reviews, 2002, p. 473.
11.  Collin at 477.
12.  National Digestive Diseases Information Clearinghouse.
13.  Ibid.
14.  Peter H.R.Green and Rory Jones, Celiac Disease:  A Hidden Epidemic (New York, HarperCollins) 2006, pgs 48-49.
15.  Kenneth Fine, M.D., Enterolab Frequently Asked Questions, 2006.
Related Posts Plugin for WordPress, Blogger...