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Celiac.com 08/05/2017 - I was told that I had irritable bowel disease about thirty years before being diagnosed with celiac disease. I avoided hard to digest foods such as corn, broccoli, beef and other foods difficult to digest, and instead I would, for instance, eat the bun of a hamburger, avoid steaks but eat the buttered buns and the gravy with a main meal and wondered why I was still having the gut and bowel reactions! Did you know that even in the absence of fully developed celiac disease, gluten can induce symptoms similar to FBD (Functional Bowel Disorder)? Doctors such as Elena F. Verdu, David Armstrong and Joseph Murray describe celiac disease and irritable bowel syndrome (IBS) as the "no man's land of gluten sensitivity.” Celiac disease is a condition traditionally characterized by chronic inflammation of the proximal small intestine resulting in villus atrophy and malabsorption. Irritable bowel disease is a clinical syndrome defined in the most recent Rome III consensus by the presence of abdominal pain or discomfort, at least three days per month in the last three months, and two or more other symptom features: 1) Improvement in defecation, 2) Association with a change in stool frequency, and 3) Association with a change in stool form or appearance. Other GI symptoms, such as bloating and distension are also considered to be consistent with a diagnosis of FBD (Functional Bowel Disorder) such as IBS. Did you know IBS has a prevalence of about 10% and is the most common GI disorder in our society, imposing a very high economic burden in North America? Did you know that there is an overlap between IBS and celiac disease? It has been reported that testing for celiac disease in patients with diarrhea-predominant IBS is cost effective if the prevalence of celiac disease is above 1%. Not only do the symptoms of IBS and celiac disease overlap, but epidemiological studies also suggest a greater than by chance association (4 - 5 fold increased risk). By convention, a patient with confirmed celiac disease is no longer considered to have IBS. It has never been determined whether celiac disease and IBS cannot co-exist, and there is no reason to think that a diagnosis of celiac disease necessarily precludes a diagnosis of IBS. Dr. Fasano has concluded that about 3% of patients with a "clinical" presentation of IBS were subsequently diagnosed with celiac disease. I would wager that many of you with confirmed celiac disease may also have the symptoms of irritable bowel disease. I cannot be alone in this! I can check off the symptoms of IBS on many occasions and yet I have diagnosed celiac disease and dermatitis herpetiformis. In Dr. Fasano's report: "they have concluded that gluten induced Patho-physiology may constitute an underlying factor in symptom generation in a proportion of patients with IBS like symptoms." A lot of this wording may seem like Greek or a "little over ones head" so to speak, but I believe what they are saying is though we define gluten sensitivity as a condition of some morphological, immunological, or functional disorder that responds to gluten exclusion and NOT a true disease. Gluten sensitivity changes that occur with IBS because of exposure to gluten are eventually going to show up positive for celiac disease. Why would a person who has been diagnosed and KNOWS that they have irritable bowel disease continue to ingest gluten when Fasano et. al., have concluded that about 3% of patients with a "clinical" presentation of IBS were subsequently diagnosed with celiac disease? Did you know that in July of 2016 teams of researchers at Columbia University published a study confirming that wheat exposure response is, in fact triggering a systemic immune reaction and accompanying intestinal cell damage. "It is estimated that the impacted population is equal to or even exceeds the number of individuals with celiac disease, the vast majority of whom remain undiagnosed" Dr. Armin Alaedin confirmed. Finally they are reporting that a person with irritable bowel disease may have gotten that way from ingesting gluten. Celiac Disease and Dermatitis Herpetiformis – Did You Know? 15 - 25% of individuals with celiac disease experience dermatitis herpetiformis? Dermatitis herpetiformis is a skin manifestation of celiac disease and is part of the abnormal immune response to gluten; Affects more men than women? Dermatitis herpetiformis generally starts in adulthood. It is not common to see dermatitis herpetiformis in children, but it can occur; Only about 20 percent of people with dermatitis herpetiformis have intestinal symptoms of celiac disease, however, biopsies show that 80 percent have some degree of damage to the small intestine, especially if a high gluten diet is maintained; If you suspect dermatitis herpetiformis you may have celiac disease; Iodine is something that a person with dermatitis herpetiformis should definitely avoid; One of the oldest checks for dermatitis herpetiformis was putting some iodine on ones thigh; Dermatitis herpetiformis sores tend to run in a line, or stay in a cluster; Dermatitis herpetiformis treatment consists of a gluten-free diet for life, just like in celiac disease? The skin's response to the gluten-free diet is much slower compared to the healing of the intestines in those with celiac disease. It may take about six months to achieve improvement, though with my own dermatitis herpetiformis spots daily dapsone was miraculous. It did take up to a year for the sores in my scalp to heal. Dr. John Zone, M.D. Professor and Dermatology Chair at the University of Utah and CDF Medical Advisory Board member states "There is little question that ingestion of large amounts of iodine dramatically worsens dermatitis herpetiformis," he continues, "iodine does not cause dermatitis herpetiformis. It worsens dermatitis herpetiformis. Gluten causes dermatitis herpetiformis." Dr. Zone explains that through seeing hundreds of celiac disease patients over the years, he has found that some react to highly concentrated solutions of iodine in cough medicines, shellfish, and kelp, which is often found in Sushi. He also cautions that dietary supplements may contain large amounts of kelp or iodine (usually in the form of potassium iodide or sodium iodide) which can worsen dermatitis herpetiformis. I can share with you that I was incorrectly told over 25 years ago by an internist that I could take up to five dapsone, going 5- 4 - 3- 2 -1, and if the spots had not totally disappeared I could repeat the process. Taking too much cased a blood disorder called Methemaglobinemia, a rare but dangerous response to taking too much dapsone. It is a blood disorder in which an abnormal amount of methemoglobin is produced. Hemoglobin is the protein in red blood cells (RBCH's) that carries and distributes oxygen to the body. Methemoglobin is a form of hemoglobin, with it the hemoglobin can carry oxygen, but is not able to release it effectively to body tissues. It can either be passed down through families (inherited or congenital) or be caused by exposure to certain drugs, chemicals, or foods (acquired). My nephew was on dapsone, which is, according to the Head of Dermatology at the University of British Columbia, the true test of dermatitis herpetiformis. By taking Dapsone for three or four days the lesions (itchy/sore blisters that beg to be itched, and when you do you break open a lesion that appears to contain liquid...they burn, then they crust, and if you continue to pick off that crust they scar your skin.) almost disappear like magic. My nephew thought it was permissible to cheat once in a while and thought that he could get away with it. He used to eat hamburgers every time the craving for a "Big Mac" overcame him! He ate one, or maybe two, until he found out he had dermatitis herpetiformis sores on the soles of his feet and was limping from the pain. Who knows what damage he was doing to the villi in his bowel! It is a vast no man's land out there, but if you are a celiac and have dermatitis herpetiformis or are gluten sensitive you need to step into that “land” and learn more about the diseases and what is going on in your body!

Celiac.com 04/10/2013 - People with celiac disease or inflammatory bowel disease have higher rates of migraine headaches than their counterparts without those conditions, according to a new study. The research team included Alexandra K. Dimitrova MD, Ryan C. Ungaro MD, Benjamin Lebwohl MD, Suzanne K. Lewis MD, Christina A. Tennyson MD, Mark W. Green MD, Mark W. Babyatsky MD, and Peter H. Green MD. A team of researchers recently set out to assess the rates of migraine headaches in clinic and support group patients with celiac disease and inflammatory bowel disease (IBD) and to compare those with a sample group of healthy control subjects. A number of European studies have shown higher rates of migraine headaches in patients with celiac disease and IBD compared with control subjects. For the study, participants all answered a self-administered survey containing clinical, demographic, and dietary data, as well as questions about headache type and frequency. They also used both the ID-Migraine screening tool and the Headache Impact Test (HIT-6). The research team analyzed five hundred and two subjects who met exclusion criteria. Of these, 188 had celiac disease, 111 had IBD, 25 had gluten sensitivity (GS), and 178 healthy subjects served as controls. Thirty percent of celiac patients, 56% of gluten-sensitive patients, 23% of IBD patients, and 14% of control subjects reported chronic headaches (P < .0001). Using multivariate logistic regression, the team found that all subjects with celiac disease (odds ratio [OR] 3.79, 95% confidence interval [CI] 1.78-8.10), GS (OR 9.53, 95% CI 3.24-28.09), and IBD (OR 2.66, 95%CI 1.08-6.54) had significantly higher rates of migraine headaches than did control subjects. Migraine rates were influenced by female sex (P = .01), depression, and anxiety (P = .0059) were independent predictors of migraine headaches, whereas age >65 was protective (P = .0345). When it came to grading their migraines, seventy-two percent of celiac disease subjects reported having migraine that were severe in impact, compared with 30% of IBD, 60% of GS, and 50% of C subjects (P = .0919). The number of years on gluten-free diet had no influence on the severity of migraines. Migraine headaches were more common in people with celiac disease and IBD patients than in control subjects. The team points out that future studies should screen migraine patients for celiac disease and assess the effects of gluten-free diet on celiac disease patients with migraines. Source: Headache: The Journal of Head and Face Pain. DOI: 10.1111/j.1526-4610.2012.02260.x

Celiac.com 07/29/2015 - Numerous studies have shown that a high percentage of patients with irritable bowel syndrome (IBS) are also sensitive to gluten. A team of researchers recently set out to evaluate the effect of a gluten-free diet on gastrointestinal symptoms in patients with IBS. The research team included B. Shahbazkhani, A. Sadeghi, R. Malekzadeh, F. Khatavi, M. Etemadi, E. Kalantri, M. Rostami-Nejad, and K. Rostami. They are variously affiliated with the Gastroenterology Unit of Imam Khomeini Hospital at the Tehran University of Medical Sciences, Tehran, Iran, the Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran, the Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Clinic, Tehran, Iran, the Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran, the Gholhak Medical Laboratory, Tehran, Iran, the Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran, and with the Department of Gastroenterology, Alexandra Hospital, Worcestershire, UK. For their double-blind randomized, placebo-controlled trial, the team enrolled 148 IBS patients who fulfilled Rome III criteria between 2011 and 2013. Unfortunately, only 72 out of the 148 remained on a gluten-free diet for the six weeks needed to complete the study. The team recorded clinical symptoms biweekly using a standard visual analogue scale (VAS). In the second stage after six weeks, patients whose symptoms improved to an acceptable level were randomly divided into two groups; The first group of 35 patients received packages containing powdered gluten, while 37 patients received a gluten-free placebo powder. Nearly 84% of the gluten-free placebo group showed a significant improvement in symptoms compared to just under 26% for the gluten consuming group (p < 0.001). This study confirms that a large number of patients diagnosed with irritable bowel syndrome are sensitive to gluten. The team suggests that the term of IBS might be misleading and may change or delay an "effective and well-targeted treatment strategy in gluten sensitive patients." Source: Nutrients. 2015 Jun 5;7(6):4542-54. doi: 10.3390/nu7064542.

Celiac.com 11/28/2012 - A team of researchers recently set out to determine whether childhood antianaerobic antibiotic exposure is associated with the development of inflammatory bowel disease (IBD). Their findings show that children who are treated with antianaerobic antibiotics face a significantly higher risk of developing IBD. The team included Matthew P. Kronman, MD, MSCE, Theoklis E. Zaoutis, MD, MSCE, Kevin Haynes, PharmD, MSCE, Rui Feng, PhD, and Susan E. Coffin, MD, MPH.They are affiliated variously with the Division of Infectious Diseases, Seattle Children’s Hospital at the University of Washington in Seattle, Washington, the Division of Infectious Diseases at The Children’s Hospital of Philadelphia, and the Department of Biostatistics and Epidemiology, the Center for Clinical Epidemiology and Biostatistics at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, Pennsylvania. The team's findings appear in the 24 September issue of Pediatrics. To get a better picture regarding use of antibiotics on children and a possible connection to IBD, the team conducted a retrospective cohort study using data from 464 UK ambulatory practices in The Health Improvement Network. The study looked at all children in the network with 2 or more years of follow-up from 1994 to 2009. The team screened and excluded anyone with previous IBD. They then cataloged all antibiotic prescriptions used by all children in the study. Finally, they tracked the children's data from practice enrollment and IBD development, practice de-registration, 19 years of age, or death. Their defined study parameters included the following antianaerobic antibiotics: penicillin, amoxicillin, ampicillin, penicillin/β-lactamase inhibitor combinations, tetracyclines, clindamycin, metronidazole, cefoxitin, carbapenems, and oral vancomycin. Their study looked at 1,072,426 children for a total of 6.6 million person-years of follow-up. Of those children, 748 developed IBD. Children treated with antianaerobic antibiotics had nearly 1.52 cases of IBD per ten-thousand person years, while those who were not given antibiotics saw just 0.83 cases per ten-thousand person-years; for an 84% relative risk differential. Antibiotic exposure throughout childhood was associated with the development of IBD, but this relationship decreased with increasing age at exposure. That is, the longer doctors waited to give children antibiotics, the more the risk of iBD went down. Children treated with antibiotics before 1 year of age showed an adjusted hazard ratio of 5.51 (95% confidence interval [CI]: 1.66–18.28), while that decreased to 2.62 (95% CI: 1.61–4.25) for children first treated at 5 years old, and to 1.57 (95% CI: 1.35–1.84) for those first treated at 15 years of age. Overall, each course of antibiotics increased the IBD hazard by 6% (4%–8%). The study showed that children who received two or more antibiotic courses were more highly likely to develop IBD than those who received 1 to 2 courses, with adjusted hazard ratios of 4.77 (95% CI: 2.13–10.68) versus 3.33 (95% CI: 1.69–6.58). So, based on this study, treating children with antianaerobic antibiotics puts them at risk for developing IBD. It will be interesting to see how the medical community responds to this study, and whether there is greater effort made to avoid giving these powerful antibiotics to children. What do you think? Do you have IBD? Did you receive these antibiotics as a kid? Let us know your thoughts by commenting below. Source: Pediatrics; 24 September 2012

Celiac.com 07/17/2012 - To follow up on reported associations between celiac disease and peripheral neuropathy, a research team recently conducted a study of peripheral neuropathic symptoms in celiac disease and inflammatory bowel disease. T.C. Shen, B. Lebwohl, H. Verma, N. Kumta, C. Tennyson, S. Lewis, E. Scherl, A. Swaminath, K.M. Capiak, D. DiGiacomo, B.P. Bosworth, T.H. Brannagan 3rd, and P.H. Green. They are affiliated with the Department of Medicine, Division of Digestive and Liver Diseases at Columbia University Medical Center in New York, NY. For their study, the team recruited patients celiac disease and/or inflammatory bowel disease from the gastroenterology clinics at a medical center and local support groups. The team recruited control subjects without celiac disease or inflammatory bowel disease from the staff of the medical center, and from relatives and attendees at support groups. Researchers had each participant complete a survey that used two validated peripheral neuropathy standards to define and characterize peripheral neuropathy. The team found that 38.9% of participants with celiac disease and 38.7% in the inflammatory bowel disease group (P = 0.97) met criteria for peripheral neuropathy compared with 20.5% in the control group (P < 0.001). Using multiple logistic regression, the researchers found that those with celiac disease had higher odds of peripheral neuropathy (odds ratio, 2.51; 95% confidence interval, 1.82-3.47), adjusted for age, gender, diabetes, vitamin B12 deficiency, and cancer history; as did those with inflammatory bowel disease (odds ratio, 2.78; 95% confidence interval, 1.85-4.18). The results showed that people with celiac disease and/or inflammatory bowel disease had higher rates of peripheral neuropathy than did the general population. Source: J Clin Neuromuscul Dis. 2012 Mar;13(3):137-45.

Celiac.com 05/18/2011 - Irritable Bowel Syndrome (IBS) is based on a clinical description only; there are no pathophysiological pathways definitively associated with it. It is characterized as gastrointestinal symptoms with no discernable cause. A diagnosis of IBS depends on recurrent abdominal pain or discomfort for at least three days per month in the last three months, with the onset of the discomfort either associated with a change in frequency or appearance of stool or alleviated by defecation. A number of different mechanisms have been suggested as potential causes of IBS. These range from psychological origins, to increased visceral hyperalgesia (sensitivity to pain), to the low grade gut inflammation and altered gastrointestinal permeability and motility observed in IBS patients. Complicating matters is that most patients exhibit only a subset of symptoms. Since gluten has been demonstrated to negatively affect even people without celiac disease by an unknown mechanism (see Study Shows Gluten Intolerance Without Celiac Disease), and the underlying causes of IBS remain unclear, Dr. Elena Verdu wondered if gluten might contribute to IBS. Like those with IBS, patients with gluten sensitivity lack the antibodies against tissue transglutaminase that are the hallmark of celiac disease but nonetheless suffer immune mediated inflammation in their gut. Interestingly, when IBS patients without celiac eliminated gluten from their diet, 68% of them reported more severe pain, bloating, and tiredness upon gluten rechallenge. But how – by what mechanism? No changes were detected in intestinal permeability or fecal lactoferrin, a marker of intestinal inflammation. However, it is possible that these phenomena persisted, just at below the level of detection. Based on these data, and other evidence that is rapidly accruing suggesting that gluten can negatively affect those without celiac disease, Dr. Verdu suggests that IBS patients might be screened for anti-gliadin antibodies even if they lack antibodies against tissue transglutaminase. These nonspecific antibodies can indicate an immunological response to gluten, and thus their presence could used to determine if their symptoms might be alleviated by adherence to a gluten free diet. She makes sure to point out, though, that this is probably not the case for all IBS patients. Source: Am J Gastroenterol 2011; 106:516–518

Celiac.com 03/04/2011 - Celiac disease is similar to the inflammatory bowel diseases, ulcerative colitis and Crohn’s disease, in the obvious sense that all are chronic inflammatory disorders of the gastrointestinal tract. But more than that, they all also present daily psychological and social challenges to patients’ lifestyles. In a recent study reported in the European Journal of Gastroenterology and Hepatology, researchers in the United Kingdom examined the prevalence of GI symptoms in patients with these diseases and correlated the incidence of these symptoms with quality of life (QoL). Not surprisingly, they found that increased severity of reflux and irritable bowel syndrome were associated with a diminished QoL. Patients with celiac disease had worse symptoms and QoL than those with ulcerative colitis, but they were better off than people with Crohn’s disease. This cross-sectional study was performed by sending patients surveys through the mail. One thousand and thirty-one people were included; 225 patients with celiac, 228 with ulcerative colitis, 230 with Crohn’s disease, and 348 healthy age- and sex-matched controls. As this was a postal survey, there is a potential inclusion bias – it is possible that those patients faring the worst would be most likely to send back the questionnaires. Seventy one percent of the celiac patients reported adhering to a gluten-free diet, but this was not corroborated endoscopically. One of the surveys assessed physical and mental QoL and another considered depression and anxiety. Participants were also asked to report and rate GI symptoms they had experienced over the past month, including reflux, heartburn, regurgitation, belching, dysphagia (difficulty swallowing), and retrosternal pain. Barrat et al. found that the celiac patients had higher rates of belching and dysphagia than inflammatory bowel diseases sufferers in this study and also than reported previously. They highlight that despite the high (71%) degree of adherence to the gluten-free diet, 22% of celiac patients still reported severe enough IBS symptoms to affect their QoL. They infer from this finding a couple of noteworthy things. First, that the gluten-free diet may not adequately control IBS symptoms in celiac patients. But also, that doctors are perhaps not inquiring about reflux and IBS during consultations, or patients are under-reporting their prevalence. The authors thus suggest that QoL might be improved for these patients if doctors were more diligent in assessing them for reflux and irritable bowel syndrome. Source: European Journal of Gastroenterology & Hepatology: February 2011 - Volume 23 - Issue 2 - p 159–165

Celiac.com 05/28/2010 - Celiac disease research is linking Irritable Bowel Syndrome with gluten intolerance and doctors are recommending IBS sufferers, especially those with diarrhea-predominant IBS, to get tested for gluten issues or celiac disease. Celiac disease is an autoimmune disease. The source of this being gluten, a protein found in wheat, barley, and rye, often affecting the entire body and manifesting various physical and mental symptoms, and a gluten-free diet is the simple treatment for this disease. New research published in the Archives of Internal Medicine has shown that people with IBS are four times more likely to have celiac disease than those without IBS. Doctors, often uneducated about celiac disease or improperly taught that its symptoms are dramatic, don’t associate the common symptoms of IBS, stomachaches, bloating, fatigue, and diarrhea, with celiac disease or gluten intolerance. In the January 2009 issue of the American Journal of Gastroenterology, the American College of Gastroenterology began recommending that doctors screen patients who manifest symptoms of IBS for celiac disease as well. The diagnosis is easy to test for. Simple blood tests detect the disease over ninety percent of the time. The diagnosis is then confirmed by an upper endoscopy. A small, flexible tube is slipped into the mouth of the sedated patient, down his esophagus and stomach and into the first part of the small intestine, where biopsies are taken and then examined for changes seen in celiac disease. After a correct diagnosis is made, people with IBS who are also celiac can begin the rapid road to recovery with a gluten-free diet. As people become more aware of celiac disease and gluten intolerance, gluten-free foods and gluten-free cooking become more and more available. There are now many delicious gluten-free recipes available for favorite foods and desserts such as gluten-free pizza, gluten-free muffins, and gluten-free cupcakes. Adults and children alike who are gluten intolerant can still enjoy a gluten-free balanced diet with a variety of gluten-free choices. In the U.S., a slightly increased rate of celiac diagnosis among adults has already lead to increased support. Gluten-free foods and gluten-free recipes are more readily available than ever. The Gluten-Free Restaurant Awareness Program (GFRAP) assists in the mutually beneficial relationship between people diagnosed with celiac disease or gluten intolerance and restaurants, resulting in an increase in the number of restaurants which can provide service to people following a gluten-free diet while increasing their patronage. Participating restaurants are able to provide gluten-free meals. As more and more people are diagnosed with gluten intolerance, their list of participating restaurants will surely grow. However, the U.S. remains behind in celiac awareness. This probably has something to do with the fact that celiac disease is the only autoimmune disease that the government doesn’t support with research grants. Centers such as Dr. Green’s Celiac Disease Research Center are one-hundred percent dependent on charitable donations or university funds. Even though diagnosis is slightly up for celiac adults, this isn’t enough to raise awareness and bring relief for the three million people who suffer from celiac disease, nearly ninety-seven percent of whom don’t even know the cause of their painful symptoms. With increased diagnosis, we will surely see increased support, and soon the celiac community will be able to enjoy the same quality of life and food and cooking options which is enjoyed by, for instance, the lactose-intolerant community. If you have been diagnosed with IBS or have similar symptoms, make an appointment with your doctor today to get tested for celiac disease or gluten intolerance. It may just bring you the relief you’ve been looking for all these years.