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  • Jefferson Adams
    Jefferson Adams
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    Many Cases of IBS and Fibromyalgia Actually Celiac Disease in Disguise

    Celiac.com 12/30/2013 - Irritable bowel syndrome (IBS) and fibromyalgia syndrome (FMS) often occur together, and research indicates that many people with IBS plus FMS (IBS/FMS) might actually suffer from undiagnosed celiac disease.

    Photo: CC--RosefirerisingTo better understand the potential connection between the two, a team of researchers recently conducted an active case finding for celiac disease in two IBS cohorts, one constituted by IBS/FMS subjects and the other by people with isolated IBS.

    The research team included L. Rodrigo, I. Blanco, J. Bobes, F.J. de Serres. They are affiliated with the department of Gastroenterology at the Central University Hospital of Asturias (HUCA), Celestino Villamil in Oviedo in the Principality of Asturias, Spain.

    For their study, the team included 104 patients (89.4% females), fulfilling the 1990-ACR criteria for FMS and the Roma III criteria for IBS classification, along with 125 unrelated, age and sex matched IBS non-FMS patients.

    All patients underwent the following studies: hematological, coagulation and biochemistry test, serological and genetic markers for celiac disease (i.e., tissue-Transglutaminase-2, tTG-2, and major histocompatibility complex HLA-DQ2/DQ8); multiple gastric and duodenal biopsies; FMS tender points (TPs); fibromyalgia impact questionnaire (FIQ), health assessment questionnaire (HAQ), short form health survey (SF-36), and visual analogue scales (VAS) for tiredness and gastrointestinal complaints.

    Overall results showed that IBS/FMS patients scored much worse values in quality of life and VAS scales than those with isolated IBS (p

    These seven patients showed substantial improvement in digestion and symptoms once they adopted gluten-free diets.

    The findings of this screening indicate that a significant percentage of IBS/FMS patients actually have celiac disease. These patients can improve symptoms and possibly prevent long-term celiac-related complications with a strict lifelong gluten-free diet.


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    Guest nancy D'Antonio

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    We need lots of info and healthy suggestions for eating. I have arthritis, gluten and lactose issues...never diagnosed as IBS or celiac but not sick & feel better on gluten free diet.

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    My Mother has struggled for the last 10 years with her health (Gastrointestinal issues and FMS) and still continues to feel exhausted and ill, although on medications. I will share this article and continue to encourage her to be gluten-free. Thank you!

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    We need to get the medical professionals trained regarding celiac diagnosis and treatment. There are only a very few Doctors and medical people who know anything about celiac and they all seem to be at universities. It is amazing how ignorant the medical profession is regarding this tragic medical condition.

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    We need to get the medical professionals trained regarding celiac diagnosis and treatment. There are only a very few Doctors and medical people who know anything about celiac and they all seem to be at universities. It is amazing how ignorant the medical profession is regarding this tragic medical condition.

    Here in Spain it is almost impossible to find a doctor who knows anything much about celiac and gluten intolerance, even worse they don't seem to be interested in finding out and ridicule patients who through necessity have investigated these problems themselves.

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    One needs to consider that it might not be the gluten per say but the fermentable carbohydrates and fructose in wheat that is causing these patients symptoms. The study does not tell us what the biopsies showed in terms of any signs of villi atrophy, thus they can not make the final conclusion that it is actually the gluten causing their symptoms. SIBO and/or FODMAP intolerance could be causing their symptoms and wheat is a highly fermentable carbohydrate which can bring on both FM symptoms and if dietary changes are not made, can bring on Small Intestinal Bacterial Overgrowth.

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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
    Mayo Clin Proc 2004;79:476-482. Celiac.com 05/25/2004 - The results of a study conducted by Dr. G. Richard Locke III and colleagues at the Mayo Clinic College of Medicine in Rochester, Minnesota do not show an association between irritable bowel syndrome (IBS) and celiac disease. The case-control study was based on the respondents of a bowel disease questionnaire that was sent to random Olmsted County residents who were 20 to 50 years old. The researchers evaluated 150 subjects, 72 of whom reported having symptoms of IBS and dyspepsia, and 78 controls with no gastrointestinal symptoms. In the group with symptoms they found that 50 had IBS, 24 had dyspepsia and 15 had both conditions. Serological screening of both groups for celiac disease showed no significant difference between them—two controls, two IBS subjects and two people with dyspepsia tested positive for celiac disease. The researchers conclude that celiac disease alone cannot explain the presence or IBS or dyspepsia in the subjects.
    The results of this study are interesting, but probably not large enough to be statistically significant. The total number of people with celiac disease in each group was astounding:
    2 out of 50 with IBS (4%)
    2 out of 24 with dyspepsia (6%)
    2 of the 78 controls (2.6%)
    These findings do not necessarily contradict previous IBS/celiac disease studies that looked at hospital outpatients who are more likely to have more severe and prolonged symptoms than a group that selects itself from the general public by responding to a questionnaire. Additionally most of the earlier studies that concluded that there was a connection between celiac disease and IBS were conducted before more recent epidemiological studies that have shown just how high the incidence of celiac disease in the general population is--now estimated between 0.8% and 1.3%--this study suggests 2 -3%. These recent epidemiological studies have also shown that a large percentage of celiacs have little or no symptoms, perhaps due to the length of time or the severity of the disease.
    A 1 in 20 diagnosis of celiac disease in patients with IBS/dyspepsia is consistent with other studies, and is still high and suggests that testing for celiac disease should be done routinely on these patients. No studies have ever suggested that all or even most IBS patients have celiac disease, just that the incidence is higher than that of the normal population.
    I propose that if this study had been done on exactly the same people several years from now, the 2 people in the control group who were found to have celiac disease may well develop symptoms that would put them in either the IBS or dyspepsia group, which would create a statistically significant result that would contradict this studys result. Last, perhaps the results of this study really support a more broad conclusion: Everyone ought to be screened for celiac disease, not just those with symptoms.

    Jefferson Adams
    Celiac.com 05/06/2008 - In the majority of people with celiac disease,strict adherence to a gluten-free diet can result in a quality of lifethat is on par with non-celiacs. Still a small percentage of celiacsseem to suffer from persistent gastrological discomfort in the form ofirritable bowel or irritable-bowel-like symptoms. Very few studies havebeen done on persistent gastrological problems in adults with celiacdisease. Those that have been done rely upon univariate statisticalanalysis in clinical samples at the secondary or tertiary care leveland fail to assess the potential influence of non-celiac diseasespecific factors, which are considered to be a risk factor of irritablebowel syndrome (IBS), such as mental disorders, or gender.
    Ateam of researchers made up of doctors Winfried Hauser, Frauke Musial,Wolfgang Caspary, Jurgen Stein, and Andreas Stallmach set out todetermine rates of irritable bowel syndrome, irritable bowelsyndrome-related symptoms, and consecutive health care-seeking behaviorand their influence upon health-related quality of life (HRQL) and anyconceivable bio-psychosocial factors influencing adult patients withceliac disease. The research team made a medical and socio-demographicsurvey of 1000 adult celiac patients from the German Celiac Society bypost. The medical portion of the survey included bowel history. Theteam also had patients fill out a Short Form Health Survey (SFHS),along with the Hospital Anxiety and Depression Scale.
    516 ofthe questionnaires came back completed. Respondents were similar ingender ratio and median age from the whole membership directory of theGerman Celiac Society, a group of more than 18,000 people who reportedsuffering from celiac disease at the age of 18. Of these, 213 (41.3%)had a diagnosis of celiac disease that was made by a duodenal biopsy,37 (7.2%) by serological tests (celiac disease-specific antibodies), 34(6.6%) using stool tests for trans-glutaminase antibodies, and 232(45.0%) using intestinal biopsy and serological tests.
    A totalof 446 patients indicated that they had biopsy-proven celiac disease. Of these 446patients, 18 were excluded because they indicated adherence to agluten-free diet for less than 1 year. Sixteen patients were tossed outbecause they reported a major non-adherence to the gluten-free diet. Thus,the study group was confined to 412 patients with self-reportedbiopsy-proven celiac disease who were on a strict gluten-free diet for at least one year. The survey showed that out of these 412 patients that met the criteria, 96 patients, or just over 23% metmodified Rome I criteria for Irritable Bowel Syndrome. Of those 96patients, 76 patients, or nearly 80%, made an effort to get help, bothmedical and non-medical, as a result of the bowel symptoms (we’ll callthe patients who sought help "irritable bowel syndrome patients").
    Irritable bowel syndrome-like symptoms were shown to drive SFHS scores sharply downward. Mentalhealth disorders, being female, falling off the gluten-free dietall contributed to a greater likelihood of irritable bowel syndrome symptoms.
    Theresults of the study seem strengthen the bio-psychosocial model of irritable bowel syndrome, in which biological and psychological factorsare understood to affect the clinical manifestation of celiac disease.Under this model, irritable bowel syndrome-like symptoms in adults withceliac disease are understood through a combination of clinical andsocio-psychological mechanisms. This model leads doctors to anunderstanding of celiac disease and other gastro-intestinal ailmentsthat goes beyond simple biological or psychological factors alone, andlooks at factors like adverse life events, stress, and hypochondriasisamong others.
    Limited studies indicate that gender differencesin visceral perception, cardio-autonomic responses, gastrointestinalmotility, and brain activation patterns to visceral stimuli are afactor in irritable bowel syndrome. Gender differences in psychosocialfactors have not been fully studied.
    The results of this studyalso support the need for further investigation to determine exactly whatfactors contribute to the bio-psychosocial model of what is called’celiac irritable bowel syndrome.’
    Future psycho-physiologicalstudies in patients with celiac disease and irritable bowel syndromeshould look to determine if psychological discomfort can prolongmucosal inflammation, reduce visceral pain thresholds, or disturb gutmotility.
    In the event that the right psychotherapeutictreatment for irritable bowel syndrome-like symptoms and/or mentaldisorder serve to improve reduced HRQOL in adult patients with celiacdisease and irritable bowel syndrome-like symptoms, it might benecessary to take a second look at interventional practices.
    So,in a nutshell, this all means that things like mental health, gender,and other non-clinical factors might play a role in irritable bowelsyndrome-like symptoms in people with celiac disease, and that furtherstudy is needed to sort out all of the possibilities and determine ifthere might be better ways to treat celiac disease that will reduce oreliminate irritable bowel syndrome-like symptoms.
    Psychosomatic Medicine 69:370 –376 (2007)


    Jefferson Adams
    Celiac.com 10/09/2009 - The causes and mechanisms that fuel the development of gastrointestinal symptoms, along with the individual perceptions of those symptoms are varied and, in many cases, not well understood.
    A team of researchers recently set out to explore the clinical and experimental evidence regarding the possible association between gluten sensitivity, celiac disease, irritable bowel syndrome, and the development of gastrointestinal symptoms.
    The research team was made up of Elena F. Verdu, MD, PhD, David Armstrong, MA, MB, BChir, and Joseph A. Murray, MD. The team's hypothesis is that, even in the absence of fully developed celiac disease, gluten exposure can trigger symptoms that mirror FBD.
    To test that hypothesis, the team set out to see how many people with gluten sensitivity are likely to suffer from symptoms similar to functional bowel disorder (FBD).
    The team proposes model for the exploring and assessing factors influencing the development of gastrointestinal symptoms and dysfunction by gluten in FBD and organic disease.
    They elaborate on their hypothesis that gluten sensitivity and post-infectious irritable bowel syndrome (IBS) represent two triggers that can explain at least part of the wide range of IBS symptoms and dysfunction. Better understanding this relationship offers researchers a better understanding of the role of mucosal responses to luminal factors in FBDs.
    The team proposes that the animal model of gluten sensitivity in human leukocyte antigen (HLA)- DQ8 mice
    permits exploration of mucosal pathophysiological changes that develop before the onset of advanced inflammation in gluten sensitive individuals.
    A clearer picture of the means by which gluten triggers symptoms in sensitive individuals will help to shed light on the interactions between host genotype, diet, and intestinal microbiota in triggering gluten sensitivity.
    The goal of the review is to shed light on the connections between celiac disease, IBS, and gluten sensitivity, as well as to emphasize several important facts.
    First, 'gluten sensitivity' is marked by one or more various immunological, morphological, or symptomatic problems that may also be common to celiac disease and IBS.
    Second, gluten sensitivity and classic celiac disease may have common roots, but people with gluten sensitivity do not meet the clinical threshold for celiac disease.
    Third, while gluten sensitivity and IBS may share common symptomatology, gluten sensitivity by definition is not IBS.
    Successful treatments for IBS have are few, due to the lack of pharmacological targets and even a conceptualized framework for the basic pathogenetic mechanisms.
    In some patients with symptoms of post-infectious IBS, doctors have been able to associate the role of subtle persistent inflammation in as a likely trigger for gut immune responses.
    They conclude that recent clinical evidence supports the view of gluten sensitivity as the likely cause of gastrointestinal symptoms that would otherwise point to of IBS.
    This information dovetails with other recent information regarding the prevalence of gluten sensitivity. The idea that gluten sensitivity is far more widespread than believed , and that gluten sensitivity lies at the heart of numerous gastrointestinal and other systemic disorders is rapidly gaining support from data, and drawing new believers within the scientific community.
    Source:
    Am J Gastroenterol 19 May 2009; doi: 10.1038/ajg.2009.188


    Jefferson Adams
    Celiac.com 06/04/2015 - Some researchers feel that people who self report non-celiac gluten sensitivity (SR-NCGS) and also follow a gluten-free diet might actually fall within the spectrum of irritable bowel (IBS). Interestingly, recent reports suggest that large numbers of people with inflammatory bowel disease (IBD) also follow a gluten-free diet.
    A research team recently assessed the relationship between IBD and self-reported non-celiac gluten sensitivity (SR-NCGS). The team included I.Aziz, F. Branchi, K. Pearson, J. Priest, and D.S. Sanders. They are variously affiliated with the Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, United Kingdom; and the Gastroenterology and Endoscopy Unit in the Department of Pathophysiology and Transplantation at the Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplant, Università degli Studi di Milano in Milan, Italy.
    To screen for SR-NCGS and the use of a GFD, they used a cross-sectional questionnaire in 4 groups: ulcerative colitis (n = 75), Crohn's disease (n = 70), IBS (n = 59), and dyspeptic controls (n = 109). They also looked at diagnostic outcomes for IBD in 200 patients presenting with SR-NCGS.
    A total of 25 out of 59 patients with IBS (42.4%), and 40 out of 145 patients (27.6%) with IBD reported SR-NCGS. That number was just 19 of 109 for dyspeptic control subjects (17.4%). As far a gluten-free diet, currently, 11.9% of patients with IBS, and 6.2% of those with IBD are following a gluten-free diet, as compared with just 0.9% for dyspeptic controls; P = 0.02.
    For the purposes of of this study, the team made no differences between ulcerative colitis and Crohn's disease. However, 40.9% of Crohn's disease patients with SR-NCGS suffered from stricturing disease, compared with 18.9% for Chrohn's patients without SR-NCGS; (P = 0.046). Crohn's disease patients with SR-NCGS showed higher overall scores on the Crohn's Disease Activity Index (228.1 versus 133.3, P = 0.002) than those without SR-NCGS.
    The team analyzed 200 cases presenting with SR-NCGS, and found that 197 of them, or 98.5% were most likely diet-related IBS. However, 3 of the SR-NCGS patients (1.5%) actually had IBD, with all of the associated alarm symptoms, and/or abnormal blood parameters.
    The results show that SR-NCGS is not exclusive to IBS, but is also seen in some patients with IBD, which is a more severe, more debilitating condition.
    The team is calling for randomized studies to further delineate the nature of this relationship and clarify whether a gluten-free is appropriate for certain IBD patients.

    Source:
    Inflamm Bowel Dis. 2015 Apr;21(4):847-53. doi: 10.1097/MIB.0000000000000335.

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    Report on Gluten Free Foods & Beverages Market (2019) gives complete outlook of ... non-celiac patients with more number of new product introductions in ... Awareness of Celiac Disease and Gluten – Intolerance Consumers 3.1.2 ... View the full article
    Okay, thanks. Re: MTHFR - I don't really know yet... I only started reading about it yesterday and it is pretty overwhelming. But it does seem to be common advice that if you have a close relative with it you should be tested, and I guess having 2 copies of the "C" variant, as my sister has, is the "worst" variety of it.  It came to light for her when she was going through infertility and miscarriages.  They discovered that her homocysteine was high, which led to the MTHFR testing. So that is one thing I know I would then want to proceed to do, if I do have it - get my homocysteine tested. My dad died of early-onset Alzheimer's, and apparently there is a link between high homocysteine as well as the MTHFR mutation and Alzheimer's. It also seems like it would be worth knowing if I have it since it could be the cause of my lower levels of B12. And I guess maybe I would need to start taking methyl-folate? I mean, to answer your question, I am not entirely sure what I will do if I do have it.   Probably read a lot more about it... and take supplements like methyl-folate if I really think I need to.  Check my homocysteine & control that if I need to, hopefully to lower my risk of Alzeheimer's.  It seems like a frustrating area because there appear to be limited official medical websites that really even talk much about it (so far).  I have found one article on the NIH that focuses on the link with high homocysteine. I already eat a very healthy diet.  Whole grains, lots of fruit & veg, mostly organic.  I am a vegetarian except for very rare seafood. I avoid processed food and, above all, foods with added sugar...  To me, sugar is by far the worst culprit in the SAD.  I think RA has been ruled out by my 2 negative Rheumatoid Factor tests (one done several years ago, one just this year at my physical).  Also, the way this started in my elbows, and was really only there for years, is just... weird... and definitely doesn't really fit with arthritis.  And there is no swelling to speak of, just mild pain - sometimes aching, sometimes burning, sometimes sharp...  It may or may not fit with any systemic diagnosis versus a mechanical one, but nowadays I do also have pain in my hands, feet, and knees.  So then I think, well maybe it is/was something systemic, but it was worse in my elbows for some mechanical reason but now has progressed elsewhere.  I thought Crohn's was just digestive?  (Of course, many people think that of celiac.)  So I haven't really investigated that one much. My ANA was retested and is back down to "negative," so I think that pretty much rules out lupus.  I believe fibromyalgia is still on the table. Anyhow....  Your point is nonetheless taken.  I do want to rule out celiac and go from there.  At this point I'd sure love to find out it is something I could control through my diet!
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