Celiac.com 10/16/2024 - Celiac disease and fibromyalgia are two medical conditions that affect a significant number of people worldwide. While celiac disease is an autoimmune disorder triggered by gluten, fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain. Despite being distinct conditions, celiac disease and fibromyalgia share similar symptoms, such as fatigue, gastrointestinal issues, and muscle pain. This study aimed to investigate whether there is a relationship between the two conditions, focusing on whether individuals with celiac disease are more likely to develop fibromyalgia.

Celiac Disease Overview

Celiac disease is a disorder that causes the immune system to react negatively to gluten, a protein found in wheat, barley, and rye. When people with celiac disease consume gluten, their immune system attacks the small intestine, causing damage and preventing the absorption of nutrients. Celiac disease affects roughly 1% of the population, though it is more common in certain genetic groups. Symptoms of celiac disease vary and can include gastrointestinal distress, anemia, osteoporosis, skin conditions, and neurological symptoms.

In many cases, people with celiac disease experience symptoms beyond the digestive tract. These extraintestinal manifestations, such as joint pain, chronic fatigue, and depression, can often resemble fibromyalgia symptoms, making it difficult to differentiate between the two conditions.

Fibromyalgia Overview

Fibromyalgia is a chronic condition that affects the musculoskeletal system and causes widespread pain, tenderness, and fatigue. It is estimated that fibromyalgia affects 2-5% of the population, predominantly women. Common symptoms of fibromyalgia include pain, morning stiffness, non-restorative sleep, and cognitive difficulties, often referred to as "fibro fog."

Interestingly, many people with fibromyalgia also experience gastrointestinal issues, such as irritable bowel syndrome, which further blurs the line between the two conditions. This has led researchers to explore whether there is a deeper connection between fibromyalgia and other autoimmune disorders, such as celiac disease.

Study Design and Methods

This cross-sectional study examined 60 adult patients diagnosed with celiac disease based on criteria established by the American College of Gastroenterology. The study participants were evaluated for fibromyalgia symptoms using a series of diagnostic tools, including the Widespread Pain Index, the Symptom Severity Scale, and the Fibromyalgia Impact Questionnaire. These tools measure both the presence and severity of fibromyalgia in individuals.

The study sought to determine whether there was a significant correlation between the presence of celiac disease and the development of fibromyalgia. The researchers also analyzed the relationship between specific celiac disease biomarkers, such as tissue transglutaminase antibodies and endomysium antibodies, and the likelihood of developing fibromyalgia.

Results and Findings

The study found no significant relationship between the clinical presentation of celiac disease and the likelihood of developing fibromyalgia. Similarly, the results showed no correlation between the severity of celiac disease and the presence of fibromyalgia. However, the study did find that individuals with positive antibody tests, such as tissue transglutaminase antibodies, were more likely to have fibromyalgia compared to those who did not test positive for these antibodies. This suggests that the immune response triggered by gluten in celiac disease may play a role in the development of fibromyalgia.

Although the findings were not statistically significant in some areas, the study highlights the importance of recognizing the overlap between celiac disease and fibromyalgia symptoms. Given that both conditions share many similar symptoms, patients with celiac disease who experience extraintestinal manifestations, such as chronic pain and fatigue, may benefit from being evaluated for fibromyalgia.

Discussion and Implications

The potential link between celiac disease and fibromyalgia raises important questions for healthcare providers. Currently, the diagnosis of fibromyalgia is often made through exclusion, meaning that other conditions, such as autoimmune disorders, must be ruled out first. However, this study suggests that individuals with celiac disease, particularly those with positive antibody tests, may be more prone to developing fibromyalgia.

The immune system's response to gluten in individuals with celiac disease could trigger or exacerbate the chronic pain and sensitivity seen in fibromyalgia. This connection suggests that treating one condition may help alleviate symptoms of the other. For instance, maintaining a strict gluten-free diet may not only improve gastrointestinal symptoms but also reduce the severity of fibromyalgia symptoms in celiac patients.

Furthermore, the study underscores the importance of early diagnosis and treatment for both conditions. Since fibromyalgia is notoriously difficult to treat, identifying patients with celiac disease who may also have fibromyalgia could allow for more targeted therapies. Simultaneously managing the gastrointestinal symptoms of celiac disease and the musculoskeletal pain of fibromyalgia may lead to better overall outcomes for patients.

Conclusion: What This Means for People with Celiac Disease

This study's findings are particularly meaningful for individuals with celiac disease. Since celiac disease and fibromyalgia share many similar symptoms, recognizing the potential for co-occurrence could lead to earlier diagnoses and more effective treatments. For those with celiac disease, staying vigilant about extraintestinal symptoms, such as chronic pain, fatigue, and depression, may help detect fibromyalgia earlier. By working closely with healthcare providers to manage both conditions, people with celiac disease can achieve better symptom control and overall quality of life.

The study also highlights the need for further research to explore the connection between these two conditions. While the results are not definitive, they provide a starting point for future studies that could lead to more comprehensive treatment approaches for individuals affected by both celiac disease and fibromyalgia.

Read more at: hcplive.com

Celiac.com 10/19/2023 - Fibromyalgia is a condition marked by widespread pain and other symptoms. While prior research on dietary treatments for fibromyalgia has provided conflicting results, researchers recently set out to treat fibromyalgia patients with a gluten-free diet, alternated with a non-restricted gluten-containing diet, followed by a re-challenge of the gluten-free diet.

The research team included V. Bruzzese; C. Marrese; P. Scolieri; and J. Pepe. They are variously affiliated with the Department of Internal Medicine and Rheumatology, P.O. S. Spirito-Nuovo Regina Margherita Hospital, Rome, Italy; and the Department of Clinical, Internal, Anesthesiological and Cardiovascular Disease, Sapienza University of Rome, Italy. Their study aimed to understand the impact of dietary changes, specifically a gluten-free diet, on fibromyalgia symptoms in post-menopausal women.

Study Participants: Non-Celiac Post-Menopausal Women with Fibromyalgia

The study looked at twenty post-menopausal women with fibromyalgia. Importantly, none of these women had celiac disease, a known gluten-related condition.

The study followed a unique approach. Participants were first put on a gluten-free diet for six months. During this period, their pain levels were measured using the widespread pain index and symptom severity scale scores. The results were promising, with a significant reduction in widespread pain index and symptom severity scale scores. The widespread pain index decreased by approximately 24%, and the symptom severity scale decreased by about 36% after six months of the gluten-free diet.

However, what makes this study stand out is the subsequent phases. After six months of gluten-free eating, the participants were placed on a regular diet containing gluten for three months. During this period, their pain levels increased significantly, with a 74% increase in severity scale and a 21% increase in widespread pain index.

The most intriguing part is the final phase: a re-challenge of the gluten-free diet. When the participants returned to a gluten-free diet after the three months of consuming gluten, their pain levels improved significantly again. The WPI and SS scores returned to levels similar to the initial gluten-free diet phase, with a 24% decrease in widespread pain index and a 36% decrease in severity scale.

Key Findings: Statistically Significant Reduction in both the Widespread Pain Index and Symptom Severity Scale

• After six months on the gluten-free diet, there was a statistically significant reduction in both the widespread pain index and symptom severity scale, indicating an improvement in fibromyalgia symptoms.
• When participants reintroduced gluten into their diet, there was a significant increase in their pain scores (both widespread pain index and symptom severity scale).
• Notably, when they returned to the gluten-free diet after the gluten-containing "re-challenge" phase, there was once again a significant improvement in their pain scores.
• Body mass index (BMI) remained unchanged throughout the study.

The results suggest that a gluten-free diet can indeed help alleviate symptoms of fibromyalgia. This study is significant because it provides evidence that a gluten-free diet can lead to an improvement in fibromyalgia symptoms, as measured by reductions in pain scores. Moreover, the study reinforced these findings through a re-challenge phase, where participants returned to the gluten-free diet after a period of consuming gluten.

It's important to emphasize that this study involved post-menopausal women with fibromyalgia who did not have celiac disease. The dietary effects on fibromyalgia symptoms might not be the same for everyone, including celiacs, so further research is needed to understand the underlying mechanisms. Nonetheless, these findings offer hope and a potential dietary strategy for people with fibromyalgia who seek relief from their symptoms.

Also, while this research suggests a potential benefit of a gluten-free diet for fibromyalgia patients, individual responses to dietary changes can vary. Therefore, anyone considering dietary interventions for managing fibromyalgia should consult with a healthcare provider or dietitian to create a personalized plan that suits their specific needs and preferences. Additionally, more study is needed to further understand the relationship between diet and fibromyalgia and to confirm these findings in larger and more diverse populations, including people with celiac disease.

Read more at Rheumatismo.org

Celiac.com 09/19/2022 - A team of researchers recently set out to calculate rates of non-coeliac gluten sensitivity (NCGS) in a group of fibromyalgia patients, to evaluate their clinical response to a six-week gluten-free diet, any improvement in symptoms, rates of diet responders who did not meet non-coeliac gluten sensitivity diagnostic criteria, and any baseline characteristics associated with diet response and diagnostic criteria fulfillment.

The research team included Miriam Almirall, Francesc Casellas, Joan Dot, Inés de Torres, Hegoi Segurola, Sara Marsal. They are variously affiliated with the Department of Pathology, Department of Endoscopy, Department of Rheumatology, and the Nutritional Support Unit ant the Hospital Universitari Vall d’Hebron, Barcelona, Spain; the Rheumatology Research Group, Vall d’Hebron Research Institute; the Digestive System Research Unit Gastroenterology; and the Department of Morphological Sciences, Autonomous University of Barcelona.

The team carried out an uncontrolled prospective experimental study in a group of patients with fibromyalgia from a specialized hospital ward. 

The team analyzed the percentage of patients who met the Salerno Experts’ Criteria, responded to a gluten-free diet, improved their symptomatology and baseline characteristics, and met diagnostic criteria.

In all, the team found a non-coeliac gluten sensitivity rate of about 6% in 142 patients. About 22% of those showed an improvement in intestinal symptoms on a gluten-free diet. 

In total, 74.2% of the responders did not fulfil the Salerno Experts’ Criteria. The presence of diarrhea and intraepithelial lymphocytosis and lower levels of anxiety were predictive factors of gluten-free diet response. No predictive factors of non-coeliac gluten sensitivity criteria fulfilment were found due to the low number of discriminators between gluten and placebo.

These results show that patients with fibromyalgia have non-coeliac gluten sensitivity at rates similar to the general population. That means a gluten-free diet won't be appropriate for all patients with fibromyalgia. However, it could be useful for patients with diarrhea or intraepithelial lymphocytosis, at least to assess any improvement in intestinal symptoms.

Read more in Rheumatology 

Celiac.com 07/26/2017 - People with fibromyalgia often experience symptoms similar to those seen in patients with gluten-related disorders. Could these patients have some kind of hidden gluten sensitivity? Could a gluten-free diet offer improvement in their condition? Is a gluten-free diet better than hypocaloric diet for these patients?

A team of researchers recently set out to evaluate the effects of a gluten-free diet (GFD) compared with a hypocaloric diet (HCD) in a group of fibromyalgia patients.

The research team included Mahmoud Slim PhD; Elena P Calandre MD; Juan M. Garcia-Leiva PhD; Fernando Rico-Villademoros MD; Roccia Molina-Barea MD; Carmen M Rodriguez-Lopez MD; and Piedad Morillas-Arques MD. They are variously affiliated with the Institute of Neurosciences "Federico Olóriz" University of Granada, Granada, and the Department of Neuroscience and Health Sciences, University of Almeria, Almeria, Spain.

Over a 24-week period, the team fed either a gluten-free diet, or a hypo-caloric diet to adult patients diagnosed with fibromyalgia. Of the 75 total study subjects, 35 were randomly placed on gluten-free diet, and 40 on a hypo-caloric diet.

The team focused mainly on symptoms related to gluten sensitivity. They also evaluated the following secondary outcomes: body mass index, Revised Fibromyalgia Impact Questionnaire, Pittsburgh Sleep Quality Index, Brief Pain Inventory, Beck Depression Inventory-II, State-Trait Anxiety Inventory, Short-Form Health Survey, Patient Global Impression Scale of Severity, Patient Global Impression Scale of Improvement, and adverse events.

Their results showed that the least squares average change in the total number of gluten sensitivity symptoms from baseline were similar in both the gluten-free diet and hypo-caloric diet groups (−2.44±0.40 for the gluten-free diet; −2.10±0.37 for the hypo-caloric diet; P=0.343).

Both diets were well tolerated, but neither was superior in terms of the remaining measured secondary outcomes. Patients in both groups saw similar beneficial outcomes in terms of fewer gluten sensitivity symptoms and improved secondary outcomes.

However, despite better specificity, the gluten-free diet was not better than the hypo-caloric diet in reducing the number of gluten sensitivity symptoms or secondary outcomes.

At the end of the day, the gluten-free diet was no better or worse than the hypo caloric diet in treating fibromyalgia.

Source:

• Journal of Clinical Gastroenterology: July 2017 - Volume 51 - Issue 6 - p 500–507. doi: 10.1097/MCG.0000000000000651

Celiac.com 04/10/2017 - Fibromyalgia syndrome is a debilitating condition of unknown cause, and only treatment approaches at present offer only limited relief from symptoms. Some fibromyalgia sufferers seem to benefit from a gluten-free diet, but there's not a great amount of data on the benefits of a gluten-free diet in fibromyalgia sufferers who do not have celiac disease.

A team of researchers recently set out to describe 20 selected patients with fibromyalgia, but without celiac disease, whose symptoms improved when they followed a gluten-free diet. The research team included Carlos Isasi, Isabel Colmenero, Fernando Casco, Eva Tejerina, Natalia Fernandez, José I. Serrano-Vela, Maria J. Castro, and Luis F. Villa.

They are variously associated with the Department of Rheumatology, Hospital Puerta de Hierro, Majadahonda Madrid, Spain; the Department of Pathology, Hospital Infantil Niño Jesús, Madrid, Spain; the Department of Pathology, Hospital Puerta de Hierro, Majadahonda Madrid, Spain; the Department of Gastroenterology, Hospital Puerta de Hierro, Majadahonda Madrid, Spain; the Celiac and Gluten Sensitive patients Association of Madrid, Madrid, Spain; and with the Department of Immunology, Hospital Doce de Octubre, Madrid, Spain.

What researchers now call non-celiac gluten-sensitivity is a daily common, yet treatable condition, with a range of symptoms that dovetail with many symptoms of fibromyalgia, including chronic musculoskeletal pain, asthenia, and irritable bowel syndrome.

All patients underwent anti-transglutaminase assay, duodenal biopsy, and HLA typing. To rule out celiac disease in their test subjects, the research team used negative anti-transglutaminase assay results, together with the absence of villous atrophy in the duodenal biopsy.

All patients showed signs of intraepithelial lymphocytosis with no villous atrophy. The doctors defined a positive clinical response as the achievement of at least one of the following: remission of fibromyalgia-associated pain, return to work, return to normal life, or the discontinuation of opioids. Doctors followed on the patients from 5 to 31 months, with a follow-up period of 16 months, on average.

These results strengthen the idea that non-celiac gluten sensitivity may play a key role in the development of fibromyalgia syndrome.

Source:

• Rheumatol Int. 2014; 34(11): 1607–1612. Published online 2014 Apr 12. doi: 10.1007/s00296-014-2990-6

Celiac.com 01/14/2002 - Researchers led by Dr. Joel S. Edman of the Center for Integrative Medicine at Thomas Jefferson University Hospital in Philadelphia, Pennsylvania recently conducted a small and preliminary study that suggests that people with fibromyalgia may experience reductions in their symptoms if they eliminate one or more foods from their diet. The results were presented in October 2001 at the annual meeting of the American College of Nutrition in Orlando, Florida. In the study researchers reviewed the medical charts of 17 fibromyalgia patients who agreed to eliminate items such as corn, wheat, dairy, citrus, soy and nuts from their diets for at least two weeks. After the elimination of the foods, nearly half of the patients reported a significant reduction of pain, and 76% reported a reduction in other symptoms such as bloating, heartburn, headache, fatigue, and breathing difficulties. Two patients, however, reported an increase in symptoms.

After the two-week period the patients were re-introduced to the foods one at a time every 2-3 days, and many of their symptoms returned. The most common problem-causing foods for the patients in the study were corn, wheat, dairy, citrus and sugar. Dr. Edman emphasized that the findings of the study are preliminary and more research in this area needs to be done.

I know you have studied celiac disease for a long time. However, I need to disagree with the statement that fibromyalgia indicates celiac disease. It has been proven that persons with fibromyalgia have a decreased amount of serotonin and an increased amount of substance P in their spinal fluid. This indicates it is a result of not enough serotonin in the brain. Many of us who suffer from fibromyalgia do not have any problems with the digestive system at all. There are also PET scans that indicate that fibromyalgia patients have less dopamine activity in the brain indicating it truly is more a brain disease than celiac.

The posters first point differentiating celiac disease from fibromyalgia on the basis of reduced serotonin in fibromyalgia may be unaware of the finding that celiac patients have fewer serotonin receptors on their platelets (1). Although I dont know about the spinal fluid, elevated levels of substance P have also been reported in the intestinal mucosa of celiac patients (2,3,4,5). A lack of digestive problems does not rule out celiac disease, as one of the foremost researchers in that area has reported that 50% to 60% of untreated celiacs are asymptomatic (6). Altered dopamine activity has also been reported in celiac disease (7). As regards the posters contention that it is really more a brain disease than celiac disease, the connections between celiac disease and altered brain perfusion (8), epilepsy without cerebral calcifications (9), epilepsy with cerebral calcifications (10, 11), a wide variety of neuropathic symptoms (12), and a number of psychiatric ailments (13), all counter the posters perspective.

Finally, if (the poster) says that her fibromyalgia symptoms go away when gluten-free, and return when she eats gluten, I believe her.

Sources:

• Chiaravalloti G, et al. Platelet serotonin transporter in celiac disease. Acta Paediatr. 1997 Jul;86(7):696-9.
• Sjolund K, et al. Enteropathy of celiac disease in adults: Increased number of enterochromaffin cells the duodenal mucosa. Gut. 1982 Jan;23(1):42-8.
• Sjolund K, et al. Duodenal endocrine cells in adult celiac disease. Gut. 1979 Jul;20(7):547-52.
• Bloom SR. Hormonal peptides of the gastrointestinal tract. Eur J Clin Invest. 1979 Apr;9(2 Pt 1):111-3.
• Domschke S, et al. Celiac sprue: abnormalities of the hormone profile of gastroduodenal mucosa. Scand J Gastroenterol Suppl. 1989;167:86-9.
• Marsh MN, et al. Morphology of the mucosal lesion in gluten sensitivity. Baillieres Clin Gastroenterol. 1995 Jun;9(2): 273-93. Review.
• Hallert C, et al. Psychic disturbances in adult celiac disease. III. Reduced central monoamine metabolism and signs of depression. Scand J Gastroenterol. 1982 Jan;17(1):25-8.
• De Santis A, et al. Schizophrenic symptoms and SPECT abnormalities in a celiac patient: regression after a gluten-free diet. J Intern Med. 1997 Nov;242(5):421-3.
• Cronin CC, et al. Celiac disease and epilepsy. QJM. 1998 Apr;91(4):303-8.
• Bernasconi A, et al. Celiac disease, bilateral occipital calcifications and intractable epilepsy: mechanisms of seizure origin. Epilepsia. 1998 Mar;39(3):300-6.
• Hernandez MA, et al. Epilepsy, cerebral calcifications and clinical or subclinical celiac disease. Course and follow up with gluten-free diet. Seizure. 1998 Feb;7(1):49-54.
• Hadjivassiliou M, et al. Clinical, radiological, neurophysiological, and neuropathological characteristics of gluten ataxia. Lancet. 1998 Nov 14;352(9140):1582-5
• Hoggan, R. Absolutisms Hidden Message for Medical Scientism. Interchange. 1997; 28(2/3): 183-189.