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  • Jefferson Adams
    Jefferson Adams
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    Israeli Researchers Propose Link Between Gluten and ALS

    Caption: Tel Aviv's Sourasky Medical Center. Photo: CC--SA 3.0

    Celiac.com 04/23/2015 - It's well-known that many people with celiac disease experience neuropathy and other nerve disorders. Now, a team of Israeli researchers are cautiously proposing a link between gluten reactions and ALS.

    Photo: CC--SA 3.0The research team, from the Tel Aviv Medical Center, believes that the gluten sensitivity seen in people with celiac disease might have a connection with ALS, or amyotrophic lateral sclerosis. Their study linking tissue transglutaminase 6 antibodies to ALS is the first study to document a connection between ALS and antibodies to a particular enzyme. Also known as Lou Gehrig's disease, ALS is a progressive disease that attacks nerve cells and pathways in the brain and spinal cord, eventually causing paralysis.

    In the study, researcher Vivian Drory and her team found antibodies to an enzyme produced in the brain, called tissue transglutaminase 6 (TG6), in 23 out of 150 patients with ALS, but in only five of 115 healthy volunteer subjects. Furthermore, ALS patients showed higher concentrations of those antibodies.

    It's well documented that people with celiac disease produce antibodies to another transglutaminase, TG2, when they eat gluten, a protein in wheat, barley and rye. Interestingly, nearly half (45%) of patients with celiac disease also produce antibodies to TG6, even when they have no neurological symptoms.

    Droury's team set out to evaluate the prevalence of celiac disease-related antibodies and HLA antigen alleles, as well as TG6 antibodies, in patients with ALS and healthy individuals serving as controls to determine whether a neurologic presentation of a gluten-related disorder mimicking ALS might occur in some patients.

    They conducted a case-control study in an ALS tertiary center, where they measured serum levels of total IgA antibodies, IgA antibodies to transglutaminase 2 (TG2) and endomysium, along with IgA and IgG antibodies to deamidated gliadine peptide and TG6 and performed HLA antigen genotyping in 150 consecutive patients with ALS and 115 healthy volunteers of similar age and sex.

    Study subjects did not have any known autoimmune or gastroenterologic disorder, and none was receiving any immunomodulatory medications.

    The team found that ALS patients with antibodies to TG6 showed the classic picture of ALS and the typical rate of disease progression. The volunteers with antibodies to TG6 showed no signs of any disease.

    All patients and control group participants were seronegative to IgA antibodies to TG2, endomysium, and deamidated gliadine peptide. Twenty-three patients (15.3%) were seropositive to TG6 IgA antibodies as opposed to only 5 controls (4.3%) (P = .004). The patients seropositive for TG6 showed a classic picture of ALS, similar to that of seronegative patients.

    The team tested fifty patients and 20 controls for celiac disease-specific HLA antigen alleles; 13 of 22 TG6 IgA seropositive individuals (59.1%) tested seropositive for celiac disease-related alleles compared with 8 (28.6%) of the 28 seronegative individuals (P = .04).

    Average levels of IgA antibodies to TG6 were 29.3 (30.1) in patients and 21.0 (27.4) in controls (P = .02; normal, <26). Average levels of IgA antibodies to TG2 were 1.78 (0.73) in patients and 1.58 (0.68) in controls (normal, <10). In a subset of study participants, mean levels of deamidated gliadin peptide autoantibodies were 7.46 (6.92) in patients and 6.08 (3.90) in controls (normal, <16).

    None of the ALS patients or volunteers had the antibodies to TG2 that are commonly associated with celiac disease, but the ALS patients were more likely to show the genetic mutations that put them at risk for celiac disease.

    Drory said her team has begun to study TG6 antibody levels in patients newly diagnosed with ALS, and they will be testing the effects of a gluten-free diet in some of those that test positive. However, theirs is just one report, and Drory expects it will be at least a couple of years before the team has any solid results. Her team is also inviting further input from other centers, and study of their data.

    In the meantime, she warns ALS patients against adopting a gluten-free diet without "clear evidence of antibodies," because any imbalance of diet might prove harmful. It's also worth remembering that an association is not the same as a cause. At least one earlier study concluded that there was no association between TG6 antibodies and either neurological disease or gluten itself.

    The possibility of a link between celiac disease and a degenerative nerve disease like ALS is interesting, to say the least. The findings of this team will likely invite more examination of any connection between gluten reactions and nerve disorders, so stay tuned for any follow-up news.

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    In my mid 20's I had 3 doctors in 3 states tell me, "We are pretty sure you have MS. When I was diagnosed with celiac at 49, I went on the gluten-free diet cold turkey with absolutely NO cheating. Within 3 weeks my stomach felt normal, in 3 months the borderline 'intermittent type 1 auto immune diabetes' that I had since I was 15 went into complete remission, and within 7 months the muscle weakness in my arms, legs and face were gone!

     

    One of my friends who was a baker, and who used pure "Vital Wheat Gluten" powder in his pastries died of ALS so quickly. This article points to the gluten possibly being a contributor to his death.

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  • About Me

    Jefferson Adams earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, and science. He previously served as Health News Examiner for Examiner.com, and provided health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

  • Related Articles

    Scott Adams
    Celiac.com 11/27/2002 - According to recommendations made at the 127th Annual Scientific Meeting of the American Neurological Association (ANA), a diagnosis of celiac neuropathy should be considered in patients with neuropathy of otherwise unknown etiology, including in patients without any gastrointestinal symptoms. Dr. Russell L. Chin and colleagues from the Columbia University College of Physicians and Surgeons in New York, New York reviewed the records of 20 patients who had neuropathy and biopsy-confirmed celiac disease and found that six had neuropathic symptoms with no gastrointestinal symptoms and three had the neuropathic symptoms before any symptoms of celiac disease appeared. All of the patients had burning, tingling and numbness in their hands and feet that included distal sensory loss, and nine had diffuse paresthesias that involved the face, trunk, and/or lumbosacral region. Two of these patients also exhibited weakness.
    Electromyography (nerve conduction) studies were normal or slightly abnormal in 18 of the patients and sural nerve biopsies that were examined in three of the patients revealed moderate to severe axonopathies. Thirteen of the patients tested positive for ganglioside antibodies using the agglutination assay, and celiac disease was seen in five percent of all neuropathy patients, and in 20 percent of patients who were seen at the institution for neuropathy with normal electrophysiological studies.
    Based on these results and the fact that 10 percent of patients with celiac disease exhibit associated neurological disease, usually in the form of peripheral neuropathy or ataxia, Dr. Chin recommends that all patients with neuropathy of unknown origin should be screened for celiac disease, even if they have no gastrointestinal symptoms.

    Scott Adams
    Pediatrics 2004;113:1672-1676.
    Celiac.com 07/12/2004 – According to Dr. Nathaniel Zelnik and colleagues from the Technion-Israel Institute of Technology, in Haifa, Israel, the spectrum of neurological disorders among those with celiac disease are greater than previously thought. The researchers studied 111 responses to questionnaires that probed for the presence of neurological disorders and symptoms, and reviewed the respondents medical records. Those who reported neurological symptoms underwent neurological examination and brain imaging or electroencephalogram, and the results were compared with that of 211 matched controls.
    The researchers found that 57 out of 111 (51.4%) of those with celiac disease also developed neurological disorders, compared with only 42 (19.9%) control patients. The neurological manifestations included hypotonia, developmental delay, learning disorders and ADHD, headache, and cerebellar ataxia. Epileptic disorders were also slightly more common among patients with celiac disease. The prevalence of tic disorders between the two groups did not differ. The effects of a gluten-free diet did differ among the various neurological disorders found by the researchers. Dr. Zelnik concludes that the therapeutic benefit of the gluten-free diet was demonstrated only in patients with transient infantile hypotonia and migraine headache.

    Jefferson Adams
    Celiac.com 02/09/2009 - Doctors are recommending simple, low-cost blood tests to screen for celiac disease in patients who have Restless Leg Syndrome (RLS) with low serum ferritin, but who otherwise show no clear cause for iron deficiency.
    Low iron reserves are a known risk factor Restless Leg Syndrome, as blood iron levels below 45-50ng/mL have been tied to more severe expressions of RLS. In fact, iron levels are so important to assessing RLS, that it is now common for doctors to test blood ferritin levels when first assessing Restless Leg Syndrome. Celiac disease is a common genetic disorder of the immune system that can cause iron deficiency.
    Doctors S. Manchanda, C.R. Davies, and D. Picchietti of the College of Medicine at the University of Illinois at Urbana-Champaign recently set out to determine if celiac disease might play a role in iron deficiency in patients with Restless Leg Syndrome.
    The doctors evaluated a series of four patients with Restless Leg Syndrome and blood ferritin below 25ng/mL, who had shown positive blood tests for celiac disease. Doctors confirmed celiac disease for all four patients via duodenal biopsy and positive reaction to a gluten-free diet. In each case, Restless Leg Syndrome symptoms improved, with two patients discontinuing Restless Leg Syndrome medication and two responding positively without medication.
    The doctors are recommending simple, low-cost blood tests to screen for celiac disease in patients who have Restless Leg Syndrome with low serum ferritin, but who otherwise show no clear cause for iron deficiency.
    They also note that diagnosis and treatment of celiac disease is likely to improve the outcome for those patients with Restless Leg Syndrome, as well as to better identify people at risk for the significant long-term complications associated with celiac disease.
    Restless Leg Syndrome is just the latest neurological disorder to show a connection to celiac disease. Stay tuned as more information  becomes available.

    Source: Sleep Med. 2009 Jan 10. PMID: 19138881

    Tina Turbin
    Controlling Blood Sugar and Nerve Damage: Understanding the Connection
    Celiac.com 04/04/2011 - Having been diagnosed with celiac disease, I know from having to follow a strict gluten-free diet that monitoring one's diet and health can be inconvenient, time-consuming, and challenging. Similarly, keeping one's blood sugar level under control for diabetics can be tough, but studies are showing how important this is, as it has been shown to prevent diabetic neuropathy, that is, nerve damage peculiar to diabetics, and its devastating effects.
    According to Tedd Mitchell, M.D., President of the Texas Tech University Health Sciences Center, there are two types of diabetic neuropathy, peripheral and autonomic. Peripheral neuropathy is "a degeneration of the nerves in the feet and hands," according to Dr. Mitchell, which, as it occurs "slowly but progressively," reduces sensitivity to touch while heightening sensations of pain and itching. The second type is autonomic neuropathy, which is, Dr. Mitchell says, "damage to nerves that control bodily functions, such as digestion, urination, heart rate, blood pressure, sexual function and even sweating." Some of the symptoms of this type are digestive problems, urinary problems, and reductions in blood pressure.
    The longer one has been diabetic, the higher one's risk for neuropathy. Thankfully, evidence supports that long-term blood sugar control can reduce this risk. It may seem like a challenge for some diabetics to control their blood sugar, but with some determination and effort, it can successfully be achieved.
    MedicalMoment.org, a website developed by Columbia St. Mary's, an organization of hospitals and clinics, offers various ways to get started controlling your blood sugar. First, in liaison with your health care provider, test your blood sugar and keep a record of your results and pertinent information, on a daily basis. Follow your doctor's prescribed diabetes medicine plan while eating foods low in fat, sugar, and sodium and high in fiber on a regular basis, aiming for the same caloric intake every day. It's important to get regular exercise, starting slowly if need be, such as swimming and walking. Your diet and exercise routine should be geared toward maintaining your ideal weight, which should be determined by your health care provider. You'll want to stay aware of signs of possible nerve damage such as sores that won't heal, blisters, swelling, and ulcers.
    MedicalMoment.org also offers several tips for keeping blood sugar under control. Low blood sugar should be treated quickly with the use of special glucose gel or tablets. Smoking, which harms the heart and the circulatory system, should be avoided. Next, learn as much as possible about your diabetic condition and treatment; knowledge is power in this case, as I know from being a celiac disease patient. Lastly, avoid stress and get support by staying connected with friends and relatives or a support group who can help you keep your blood sugar under control.
    It isn't unusual for me to focus some of my work as an author, researcher, and gluten-free and health advocate, on the area of diabetes; after all, according to Celiac.com, evidence is growing which supports that people with Type 1 diabetes are at high risk for celiac disease. In this research, the necessity of maintaining blood sugar is clear. With the help of your medical practitioner and other resources, you can achieve proper self-care in controlling blood sugar level and lower this risk of nerve damage.
    Resource:
    Mitchell, Dr. Tedd. "Nerve damage: One more reason to keep blood sugar under control." USA Weekend: July 9-11, 2010.


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