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    Migraines, Carpal Tunnel Syndrome, Depression, Personality Change, and Psychosis Common in Celiac Disease


    Jefferson Adams

    Celiac.com 01/19/2010 - A new study says that migraines and carpal tunnel syndrome may point to celiac disease. Moreover, 35% of people with celiac disease report a history of depression, personality changes, or psychosis. Others commonly suffer from neurological issues that are not improved with a gluten-free diet.


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    Researchers recently screened a cohort of 72 patients with biopsy-proven celiac disease, recruited through advertisements and interviewed using a standard questionnaire.

    Nearly one in three celiac patients (28%) reported a history of migraine, though numerous patients showed a decrease in frequency and intensity of migraine attacks after adopting of a gluten-free diet.

    While about 20% of patients suffered from carpal tunnel syndrome, epilepsy was, surprisingly, less common than expected," report the researchers. "Only 4 individuals presented with a history of generalized or focal seizures."

    In general, doctors believe about 6% to 10% of celiac patients show typical neurological presentations, the study authors note. Prior studies have shown cerebellar ataxia to be the most common celiac disease-associated neurological symptom.

    This new study found cerebellar ataxia in 6% of patients, and vestibular dysfunction in another 6%. In all, 26% of patients showed afferent ataxia.

    About a third of patients had problems with stance and gait, with numerous cases of deep sensory loss and reduced ankle reflexes.

    "Gait disturbances in celiac disease do not only result from cerebellar ataxia but also from proprioceptive or vestibular impairment," report investigators led by Katrin Bürk, MD, from the University of Marburg in Germany.  The bad news is that such neurological problems may develop "despite strict adherence to a gluten-free diet," says Burke.

    "Most studies in this field are focused on patients under primary neurological care," the researchers note. "To exclude such an observation bias, patients with biopsy-proven celiac disease were screened for neurological disease."

    Motor problems, such as basal ganglia symptoms, pyramidal tract signs, tics, and myoclonus, were not common. A total of 14% of patients reported problems with bladder function.

    The underlying causes for neurological problems in celiac disease are not yet understood.

    There has been some evidence to implicate deficiencies in folic acid, vitamin E, and biopterin in the pathogenesis. However, the investigators note that, in most patients, replacement therapy does not resolve clinical symptoms. They note also that hypo-vitaminosis rarely causes obvious abnormalities in celiac patients, and most with neurological symptoms show no evidence of any nutritional deficiencies.

    "The prevalence of neurological manifestations in celiac disease is striking and must be considered more than accidental," they say. "The patients' gluten-free diet had resolved intestinal symptoms but had not prevented the development of neurological deficits."

    The investigators suggest that, because of the considerable clinical variability, neurological and psychiatric dysfunction in celiac disease is likely the result of numerous pathogenic mechanisms.

    Source: Mov Disord. 2009;24:2358-2362.


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    Guest Jennifer

    Posted

    Wow - good information, even if it isn't very comforting. I wonder how they determined that the patients weren't nutritionally deficient - that was my first thought, that maybe the continued symptoms were due to a nutritional deficit.... Maybe there is a problem with uptake - ie. the blood values are normal, but the cells aren't taking in the nutrients appropriately. I guess a follow up study could be nutrient transport across cell membranes.

    Thanks for the good summary.

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    Guest Jeff Kelly

    Posted

    If a doctor believed in the tooth fairy, I doubt reporting that would be such a notable thing:similarly, what doctors "believe" is irrelevant in the entire issue of celiac disease, because they have as a whole wholly rejected the entire condition based on total ignorance and usually no desire to relieve themselves of this malady of hyperignoranceimitosis, so as a result, they lack credibility on the entire topic. Once a study published what patients believe in any manner on celiac disease--whether it be on symptoms or what foods do or some basic elementary level quite apart from the physiologic details thought of as reflective of a higher learning process--THEN I'll accept the phrase of what anyone "believes."

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    Guest kristin

    Posted

    Celiac runs on my whole dad side of the family we found out several yrs ago. Most of my family have intestinal symptoms, a few have the skin rash that goes with it. I had migraines at least 6 days a wk for yrs and was just trying to deal with them.

    When my sister encouraged me to change my diet. I soon stopped having them except with an occasional one w my period. the first couple of weeks on the diet I wasn't convinced and had 1 piece of pizza i had a migraine several hrs later that lasted for 3 days and couldn't get out of bed. That was enough to convince me. If I accidentally eat wrong I definitely feel it!My grandmother has also been in a nursing home since her late 20s w schizophrenic symptoms which I've read might be related but we have never had her diet changed to see if they might improve. We think it might have been caused by severe emotional stress for her.

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    I wonder how long they followed people with neurological effects? I have been on the diet now for going on 9 years. My ataxia has improved greatly, my depression is now gone, I have regained reflexes in my legs and while my thought processes are still a bit effected I have come much farther than I expected. I have to wonder how strict the folks they tested were that were still developing or had unresolved neuro issues. How long since diagnosis? Was this study done in Europe where they routinely put Codex Wheat Starch in foods? Something that most US celiacs know better than to eat. I also had 'carpel tunnel' and had surgery for it. It wasn't carpel tunnel at all but parathesias that were misinterpreted by the doctor. But the doc did get lots of $$$ from the unneeded surgery. Oh and I have not had one single migraine since the day I was diagnosed, unless glutened or CC'd. For what it's worth.

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    Guest Gloria Brown

    Posted

    Gluten contamination could be occurring at a molecular level undetectable by current assessments, possibly similar to homeopathy in which an element is diluted to the point at which only the wavelength of that element remains.

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    Guest tom howley

    Posted

    I have read numerous testimonies from people who improve neurological symptoms on a gluten free diet. I was recently diagnosed as gluten sensitive--I'm wondering if a gluten free diet is worth the effort. My symptoms are mostly neurological (left temple ache, left arm pain, right leg weakness, fatigue). Numerous tests have ruled out other conditions. I've also been diagnosed with eosinophilic esophagitis. Any thoughts on this?

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    Guest rick lenger

    Posted

    I wonder how long they followed people with neurological effects? I have been on the diet now for going on 9 years. My ataxia has improved greatly, my depression is now gone, I have regained reflexes in my legs and while my thought processes are still a bit effected I have come much farther than I expected. I have to wonder how strict the folks they tested were that were still developing or had unresolved neuro issues. How long since diagnosis? Was this study done in Europe where they routinely put Codex Wheat Starch in foods? Something that most US celiacs know better than to eat. I also had 'carpel tunnel' and had surgery for it. It wasn't carpel tunnel at all but parathesias that were misinterpreted by the doctor. But the doc did get lots of $$$ from the unneeded surgery. Oh and I have not had one single migraine since the day I was diagnosed, unless glutened or CC'd. For what it's worth.

    Your testimony gives me hope. I can't accept that neurological problems don't improve when we adhere to a gluten free diet. I have only been diagnosed for a year, but have noticed improvements with vertigo, and depression. I am determined to get better every day; it's a battle.

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    I have read numerous testimonies from people who improve neurological symptoms on a gluten free diet. I was recently diagnosed as gluten sensitive--I'm wondering if a gluten free diet is worth the effort. My symptoms are mostly neurological (left temple ache, left arm pain, right leg weakness, fatigue). Numerous tests have ruled out other conditions. I've also been diagnosed with eosinophilic esophagitis. Any thoughts on this?

    Definitely go off gluten! As soon as possible. I developed postural orthostatic tachycardia syndrome, had uncontrollable shaking, fainting, brain fog, sudden learning disability, eye and mouth dryness, depression, severe pms, and so much more! Going off gluten improved all conditions and I have completely recovered from most.

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  • 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.
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    Scott Adams
    Arch Neurol 2005;62:1574-1578. Celiac.com 11/29/2005 – According to Dr. Thomas H. Brannagan and colleagues at Weill Medical College of Cornell University, New York, some cases of small-fiber neuropathies are caused by untreated celiac disease and may be treatable with a gluten-free diet. The researchers report on eight patients who had neuropathy with asymmetric numbness or paresthesias in various parts of their body that began at different ages--ranging from childhood to 59 years. Out of the 8 patients in the study 5 were diagnosed with celiac disease after their neuropathy began. All patients were treated with a gluten-free diet and their neuropathy symptoms were re-evaluated--four reported improvement, one had no improvement, and 2 reported worsening of symptoms.
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    Wendy Cohan
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    Gluten ataxia is a rarely diagnosed and frequently overlooked condition* responsible for a set of symptoms usually labeled “sporadic idiopathic ataxia” - meaning that symptoms arise spontaneously and sporadically, and cannot be traced to any definitive cause.   This condition usually occurs in adults and seniors and manifests in a variety of neurological symptoms:  severe headaches, lack of muscle coordination, drooping eyelids, gait and balance disturbances, drooling, numbness, tingling, and weakness in the extremities, and problems with speech and word-finding.  Usually the client is worked up for M.S., Parkinson’s, ALS, and other neurological disorders but is negative.  Repeated MRI scans cannot pinpoint the exact cause of these symptoms, which can be severe and debilitating.  Once the diagnosis “sporadic idiopathic ataxia” is given, they are offered supportive but not curative treatment.   Fortunately, some patients are able to find a neurologist who specializes in difficult diagnoses.  Often the diagnosis of gluten ataxia is only made when the patient reveals a past positive test for gluten intolerance, family history of celiac disease, or a history of gastrointestinal problems like irritable bowel syndrome or colitis.  In the case of gluten ataxia, gluten cannot be properly digested in the body, and certain protein deposits develop in the brain, causing changes that affect the neurological system.  Complete avoidance of gluten in addition to supportive physical and cognitive therapies can sometimes reverse many of the patient’s symptoms, but complete recovery is not always possible.  A very poignant and thought-provoking article on gluten ataxia was published in “Living Without”, Spring, 2007, and it is well worth reading if you or someone in your family is experiencing problems with movement, strength, or balance.
    Peripheral neuropathy, common among diabetics, can also be related to gluten intolerance.  Neuropathy results in painful or numb extremities, including the feet, so it impairs mobility and increases the risk of falls.  It is similar to the “pins and needles” feeling one gets from siftting on the knees too long, only much more intense and constant.  The pain can be so severe that it is necessary to take pain medications.  In a book unrelated to gluten intolerance, John A. Seneff  explains that the amino acid Acetyl-L-Carnitine may have protective and restorative effects on the nerves involved in this disorder.  Interestingly, patients with celiac disease and gluten intolerance often show low levels of L-Carnitine and benefit from supplementation .
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    Gluten sensitivity as a factor in the development of schizophrenia has been substantiated by a number of epidemiological and clinical studies.  It has also been noted that this psychiatric disorder rarely occurs in countries where wheat and other gluten grains are not often consumed.
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    Jefferson Adams
    Celiac.com 06/01/2015 - Earlier research on celiac disease and neuropathy has been hampered by the use of inpatient data, low study power, and lack of information on neuropathic characteristics.
    A team of researchers recently set out to accurately assess both relative and absolute risk of developing neuropathy in a nationwide population-based sample of patients with biopsy-verified celiac disease. The research team included Sujata P. Thawani, MD, MPH; Thomas H. Brannagan III, MD; Benjamin Lebwohl, MD, MS; Peter H. R. Green, MD; and Jonas F. Ludvigsson, MD, PhD.
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    They found that patients with biopsy-verified celiac disease faced a 2.5 times higher risk of developing neuropathy (95% CI, 2.1-3.0; P < .001). Celiac patients also had an increased risk of developing chronic inflammatory demyelinating neuropathy (2.8; 1.6-5.1; P = .001), autonomic neuropathy (4.2; 1.4-12.3; P = .009), and mononeuritis multiplex (7.6; 1.8-32.4; P = .006).
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    The team found a significantly increased risk of neuropathy in patients with celiac disease, and they are recommending that doctors screen patients with neuropathy for celiac disease.
    Source:
    JAMA Neurol. Published online May 11, 2015. doi:10.1001/jamaneurol.2015.0475

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    Dr. Ron Hoggan, Ed.D.
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    Whatever the reason that stuttering has not been reported in the medical literature in association with gluten ingestion, a number of personal disclosures and comments suggesting a connection between gluten and stuttering can be found on the Internet. Abid Hussain, in an article about food allergy and stuttering said: “The most common food allergy prevalent in stutterers is that of gluten which has been found to aggravate the stutter” (10). Similarly, Craig Forsythe posted an article that includes five cases of self-reporting individuals who believe that their stuttering is or was connected to gluten, one of whom also experiences stuttering from foods containing yeast (11). The same site contains one report of a stutterer who has had no relief despite following a gluten free diet for 20 years (11). Another stutterer, Jay88, reports the complete disappearance of her/his stammer on a gluten free diet (12). Doubtless there are many more such anecdotes to be found on the Internet* but we have to question them, exercising more skepticism than we might when reading similar claims in a peer reviewed scientific or medical journal.
    There are many reports in such journals connecting brain and neurological ailments with gluten, so it is not much of a stretch, on that basis alone, to suspect that stuttering may be a symptom of the gluten syndrome. Rodney Ford has even characterized celiac disease as an ailment that may begin through gluten-induced neurological damage (13) and Marios Hadjivassiliou and his group of neurologists and neurological investigators have devoted considerable time and effort to research that reveals gluten as an important factor in a majority of neurological diseases of unknown origin (14) which, as I have pointed out previously, includes most neurological ailments.
    My own experience with stuttering is limited. I stuttered as a child when I became nervous, upset, or self-conscious. Although I have been gluten free for many years, I haven’t noticed any impact on my inclination to stutter when upset. I don’t know if they are related, but I have also had challenges with speaking when distressed and I have noticed a substantial improvement in this area since removing gluten from my diet. Nonetheless, I have long wondered if there is a connection between gluten consumption and stuttering. Having done the research for this article, I would now encourage stutterers to try a gluten free diet for six months to see if it will reduce or eliminate their stutter. Meanwhile, I hope that some investigator out there will research this matter, publish her findings, and start the ball rolling toward getting some definitive answers to this question.
    Sources:
    1. Toft M, Dietrichs E. Aggravated stuttering following subthalamic deep brain stimulation in Parkinson’s disease--two cases. BMC Neurol. 2011 Apr 8;11:44.
    2. Tani T, Sakai Y. Stuttering after right cerebellar infarction: a case study. J Fluency Disord. 2010 Jun;35(2):141-5. Epub 2010 Mar 15.
    3. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    4. Jäncke L, Hänggi J, Steinmetz H. Morphological brain differences between adult stutterers and non-stutterers. BMC Neurol. 2004 Dec 10;4(1):23.
    5. Kell CA, Neumann K, von Kriegstein K, Posenenske C, von Gudenberg AW, Euler H, Giraud AL. How the brain repairs stuttering. Brain. 2009 Oct;132(Pt 10):2747-60. Epub 2009 Aug 26.
    6. Galantucci S, Tartaglia MC, Wilson SM, Henry ML, Filippi M, Agosta F, Dronkers NF, Henry RG, Ogar JM, Miller BL, Gorno-Tempini ML. White matter damage in primary progressive aphasias: a diffusion tensor tractography study. Brain. 2011 Jun 11.
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    Jefferson Adams
    Celiac.com 06/14/2018 - Refractory celiac disease type II (RCDII) is a rare complication of celiac disease that has high death rates. To diagnose RCDII, doctors identify a clonal population of phenotypically aberrant intraepithelial lymphocytes (IELs). 
    However, researchers really don’t have much data regarding the frequency and significance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. Such data could provide useful comparison information for patients with RCDII, among other things.
    To that end, a research team recently set out to try to get some information about the frequency and importance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. The research team included Shafinaz Hussein, Tatyana Gindin, Stephen M Lagana, Carolina Arguelles-Grande, Suneeta Krishnareddy, Bachir Alobeid, Suzanne K Lewis, Mahesh M Mansukhani, Peter H R Green, and Govind Bhagat.
    They are variously affiliated with the Department of Pathology and Cell Biology, and the Department of Medicine at the Celiac Disease Center, New York Presbyterian Hospital/Columbia University Medical Center, New York, USA. Their team analyzed results of TCR-GR analyses performed on SB biopsies at our institution over a 3-year period, which were obtained from eight active celiac disease, 172 celiac disease on gluten-free diet, 33 RCDI, and three RCDII patients and 14 patients without celiac disease. 
    Clonal TCR-GRs are not infrequent in cases lacking features of RCDII, while PCPs are frequent in all disease phases. TCR-GR results should be assessed in conjunction with immunophenotypic, histological and clinical findings for appropriate diagnosis and classification of RCD.
    The team divided the TCR-GR patterns into clonal, polyclonal and prominent clonal peaks (PCPs), and correlated these patterns with clinical and pathological features. In all, they detected clonal TCR-GR products in biopsies from 67% of patients with RCDII, 17% of patients with RCDI and 6% of patients with gluten-free diet. They found PCPs in all disease phases, but saw no significant difference in the TCR-GR patterns between the non-RCDII disease categories (p=0.39). 
    They also noted a higher frequency of surface CD3(−) IELs in cases with clonal TCR-GR, but the PCP pattern showed no associations with any clinical or pathological feature. 
    Repeat biopsy showed that the clonal or PCP pattern persisted for up to 2 years with no evidence of RCDII. The study indicates that better understanding of clonal T cell receptor gene rearrangements may help researchers improve refractory celiac diagnosis. 
    Source:
    Journal of Clinical Pathologyhttp://dx.doi.org/10.1136/jclinpath-2018-205023

    Jefferson Adams
    Celiac.com 06/13/2018 - There have been numerous reports that olmesartan, aka Benicar, seems to trigger sprue‐like enteropathy in many patients, but so far, studies have produced mixed results, and there really hasn’t been a rigorous study of the issue. A team of researchers recently set out to assess whether olmesartan is associated with a higher rate of enteropathy compared with other angiotensin II receptor blockers (ARBs).
    The research team included Y.‐H. Dong; Y. Jin; TN Tsacogianis; M He; PH Hsieh; and JJ Gagne. They are variously affiliated with the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School in Boston, MA, USA; the Faculty of Pharmacy, School of Pharmaceutical Science at National Yang‐Ming University in Taipei, Taiwan; and the Department of Hepato‐Gastroenterology, Chi Mei Medical Center in Tainan, Taiwan.
    To get solid data on the issue, the team conducted a cohort study among ARB initiators in 5 US claims databases covering numerous health insurers. They used Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for enteropathy‐related outcomes, including celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy. In all, they found nearly two million eligible patients. 
    They then assessed those patients and compared the results for olmesartan initiators to initiators of other ARBs after propensity score (PS) matching. They found unadjusted incidence rates of 0.82, 1.41, 1.66 and 29.20 per 1,000 person‐years for celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy respectively. 
    After PS matching comparing olmesartan to other ARBs, hazard ratios were 1.21 (95% CI, 1.05‐1.40), 1.00 (95% CI, 0.88‐1.13), 1.22 (95% CI, 1.10‐1.36) and 1.04 (95% CI, 1.01‐1.07) for each outcome. Patients aged 65 years and older showed greater hazard ratios for celiac disease, as did patients receiving treatment for more than 1 year, and patients receiving higher cumulative olmesartan doses.
    This is the first comprehensive multi‐database study to document a higher rate of enteropathy in olmesartan initiators as compared to initiators of other ARBs, though absolute rates were low for both groups.
    Source:
    Alimentary Pharmacology & Therapeutics