-
Welcome to Celiac.com!
You have found your celiac tribe! Join us and ask questions in our forum, share your story, and connect with others.
-
Celiac.com Sponsor (A1):
Celiac.com Sponsor (A1-M):
-
Get Celiac.com Updates:Support Our Content
Search the Community
Showing results for tags 'nerve damage'.
-
Celiac.com 10/08/2022 - Celiac disease is now recognized as a spectrum of gluten-sensitive illness in which the gut is no longer seen as the sole target. For example, dermatitis herpetiformis is a skin manifestation of gluten sensitivity. Celiac disease is no longer considered just in individuals with classic intestinal damage but in individuals with other signs of immune activation and/or degrees of gut involvement, triggered by the ingestion of gluten. Substantial evidence demonstrates that the nervous system also can be a target organ with or without the presence of gut involvement(1). Neurological Complications in Celiac Disease Approximately ten percent of celiac disease patients develop neurological complications(2) . Based on case studies, the most common neurological disorders associated with celiac disease are cerebellar dysfunction, epilepsy and peripheral neuropathy. From 1964 to 2000, data compiled from case reports of 83 celiac patients with neurological complications revealed that 70% of them were diagnosed with either ataxia or peripheral neuropathy(3) . A retrospective data survey of 620 patients attending the Derby Coeliac Clinic found the following neurological and psychiatric complications: Depression (12%), epilepsy (4%), migraine (3%), carpal tunnel syndrome (2%), stroke (2%), anxiety (2%), self poisoning (2%), myopathy (1%), learning difficulty (1%), sciatica (1%), meningitis (1%), Parkinson’s disease (1%), tension headache (1%), multiple sclerosis (1%) and peripheral neuropathy (1%)2 . However, further study needs to clarify the relationship between celiac disease and these complications. A recent study found 13 (8%) among 160 celiac patients had neurological disorders(4) . Ten of the thirteen patients had central nervous system disorders such as epilepsy, attention/memory impairment, and cerebellar ataxia. The remaining patients had peripheral nervous system disorders. In eleven out of thirteen cases, the celiac disease diagnosis came after the onset of the neurological disorder. Seven celiac patients were diagnosed and treated within six months of the neurological onset. All seven had either substantial or complete resolution of their neurological symptoms. In contrast, four out of five patients who were diagnosed with celiac disease from 10 to 264 months after the appearance of their neurological disorder showed no improvement in their neurological symptoms on the gluten-free diet. This study demonstrated that the crucial timing of treatment with a gluten-free diet in celiac patients who have neurological disorders might affect whether the neurological symptoms are reversible. While the incidence of neurological complications in celiac disease is estimated to be ten percent, the incidence of celiac disease in neurological patients is still unknown. Celiac disease can escape detection in blood antibody screenings(5). Not all gluten-sensitive individuals demonstrate classic biopsy evidence of celiac disease, but exhibit milder intestinal features. Also, not all celiac patients present with gastrointestinal symptoms. Therefore, neurological patients with gluten-sensitivity may be missed if they are evaluated for neurological symptoms alone. To identify gluten-sensitivity in neurological patients, antigliadin antibodies were determined in two groups of neurological patients. In a group with idiopathic neurological illness versus another group with identifiable neurological illness, a marked difference of 57% versus 5%, respectively, were antigliadin antibody positive(2) . Twenty-six (86%) of those in the idiopathic group consented to small bowel biopsy and nine (34%) of them had intestinal features characteristic of celiac disease. However, 12% of the healthy blood donors were also antigliadin antibody positive and no explanation was given. Therefore, it was unclear whether the rate of gluten-sensitive neurological illness could be overstated by 12 percent or that 12 percent of the normal population could have gluten-sensitivity. Gluten Ataxia Gluten ataxia is the most common form of neurological dysfunction to be attributed to gluten sensitivity1 . Up to 41% of sporadic idiopathic ataxia is caused by gluten ataxia, as evidenced by the presence of antigliadin antibodies. Patients with gluten ataxia have difficulty controlling their upper and/or lower limb movements. Hadjivassiliou et al found 79% (54 of 68) of gluten ataxia patients had damage to the part of the brain called the cerebellum which is involved in coordination and steadiness. Not all gluten-sensitive, neurological patients will also have classic intestinal biopsy evidence of celiac disease. Of 51 gluten ataxia patients who underwent duodenal biopsy, 24% of them had biopsy proof of celiac disease and only 13% had gastrointestinal symptoms1 . Yet, treatment with a gluten-free diet can be helpful, irrespective of gut involvement. For example, 26 patients with gluten ataxia were offered a gluten-free diet and were confirmed to be adhering to the gluten-free diet by evidence of negative serology within six months to one year of treatment(6). When compared to the control group of patients with gluten ataxia who did not receive treatment of a gluten-free diet, all 26 patients in the treatment group improved significantly in their ataxia based on a battery of tests. The response observed in the treatment group was irrespective of gut involvement or the duration of the ataxia (mean duration of nine years). These results contrasted with the expectation that the ataxia would remain despite evidence of the loss of cerebellar Purkinje cells which are the target cells in gluten ataxia(3, 6). Malabsorption or Autoimmunity? Two potential mechanisms to explain the neurological dysfunctions of celiac disease are nutrient deficiencies due to malabsorption, and autoimmune disease. Currently, it is unknown which of these, or both, is the underlying cause of neurological disorder in celiac disease. A reference to these potential mechanisms came in 1966 when Cooke and Smith reported a landmark study of 16 adult celiac patients with neurological complications3 . For most of them, symptoms of classic celiac disease pre-existed their neurological symptoms. All 16 were found with extreme weight loss and vitamin deficiencies along with anemia due to severe malabsorption. Subsequently, over half of them died, despite gluten restriction, due to the progression of their neurological complications involving sensory ataxia and/or other features. Post-mortem findings in four patients revealed cerebellar Purkinje cell loss and T-cells (type of white blood cell) infiltrating parts of the brain, brainstem, and spinal cord(7). Deficiencies of folic acid, vitamin B-12, and vitamin E have been implicated as a potential cause of neurological complications(4). However, vitamin deficiencies alone do not explain the absence of neurological deficits in some patients(2). In addition, vitamin deficiencies are rarely found or can be attributed to neurological dysfunction in association with gluten ataxia patients of which the majority don’t have histological evidence of celiac disease(3). Furthermore, in a current study of 13 neurological celiac patients, only 2 had been diagnosed with malabsorption(4). In support of the hypothesis of an autoimmune mechanism of celiac disease neurological complications, Hadjivassiliou et al found that gluten ataxia patients with inflammation located in the white matter of the cerebellum part of the brain was marked by the loss of Purkinje cells. The inflammation in celiac disease, which is thought to be mediated by T-cells, is not confined to the small bowel as gliadin-specific T cells and antigliadin antibodies are found in the blood(8). Antigliadin antibodies also have been found in the cerebrospinal fluid(3) . In gluten ataxia patients, antigliadin antibodies were found to bind to Purkinje cells in the cerebellum that might result in damage to this part of the brain(9). This finding suggests that common binding sites are shared between cerebellar Purkinje cells and gliadin proteins. Patients with gluten ataxia also have anti-Purkinje cell antibodies. How antigliadin antibodies gain access to the cerebellum might be due to possible alterations of the blood-brain barrier. In further support of an autoimmune basis of celiac disease neurological complications, 8 of 13 celiac patients with neurological dysfunction had anti-neuronal antibodies to the central nervous system(4). This was significantly higher when compared with only 1 in 20 celiac patients who had anti-neuronal antibodies but no neurological involvement. Furthermore, 30 non-celiac control patients, who had other autoimmune gastrointestinal diseases or had donated blood, had no detectable anti-neuronal antibodies. After one year of treatment on a gluten-free diet, anti-neuronal antibodies disappeared in 6 of the 8 celiac patients with neurological dysfunction. In 5 of these 6 patients, the neurological symptoms partially or completely resolved. However, anti-neuronal antibodies are not specific for neurological disorders associated with celiac disease since they are also found in other patients with nervous system disorders. Identification of neurological patients with gluten-sensitivity with or without histological evidence of celiac disease is necessary in order to provide them the opportunity for treatment with a gluten-free diet. Identification should be further aided when the exact mechanisms of neurological complications in gluten-sensitive patients are understood. Finally, immediate treatment with a gluten-free diet early in the progression of the disease may be crucial in the prognosis of whether the neurological disorder is reversible. Glossary of Terms: ataxia: impaired muscle coordination Central Nervous System (CNS): the portion of the nervous system involving the brain and spinal cord cerebellum: portion of the brain involved in equilibrium and coordination; cerebellar (adj.) dementia: impaired intellectual function epilepsy: neurologic disease resulting in convulsions or loss of consciousness idiopathic: the disease has an unknown cause neurological: having to do with the nervous system neuron: nerve cell neuropathy: any disease of the nervous system paroxysm: convulsion Peripheral Nervous System (PNS): the portion of the nervous system outside of the brain and spinal cord; peripheral (adj.) Purkinje cell: a type of neuron that is highly branched, mostly found in the cerebellum References: Hadjivassiliou M et al 2003. Gluten ataxia in perspective: epidemiology, genetic susceptibility and clinical characteristics. Brain 126: 685-91. Tengah D et al 2002. Neurological complications of coeliac disease. Postgrad Med J 78: 393-98. Hadjivassiliou, et al. 2002. Gluten sensitivity as a neurological illness. J Neurol Neurosurg Psychiatry 72: 560-3 Volta U, et al. 2002. Clinical findings and anti-neuronal antibodies in coeliac disease with neurological disorders. Scand J Gastroenterol 37: 1276-81. Tursi A et al 2001. Low prevalence of antigliadin and anti-endomysium antibodies in subclinical/silent celiac disease. Am J Gastroenterol 96: 1507-1510. Hadjivassiliou M, et al. 2003. Dietary treatment of gluten ataxia. J Neurol Neurosurg Psychiatry 74: 1221-24. Will AJ. 2000. The neurology and neuropathy of coeliac disease. Neuropathy and Applied Neurobio 226: 493-96. Cross A, and Golumbek, P. 2003. Neurologic manifestations of celiac disease. Neurology 60: 1566-1568. Hadjivassiliou M, et al. 2002. The humoral response in the pathogenesis of gluten ataxia. Neurology 58: 1221-26.
-
- ataxia
- celiac disease
-
(and 5 more)
Tagged with:
-
Did You Know? Gluten Ataxia and Celiac Disease
Yvonne (Vonnie) Mostat, RN posted an article in Summer 2020 Issue
Celiac.com 06/12/2020 - What happens in Gluten Ataxia? Well, first, we want every celiac person to know what Gluten Ataxia is to ensure we are on the same "wave length". Gluten Ataxia is an autoimmune disorder in which the antibodies that are released in sensitive individuals when digesting gluten attack part of the brain by mistake. Since Gluten is a protein found in wheat, rye and barley, one would think that gluten exposure would have nothing to do with the brain, but since most people have no trouble with digesting this protein, others have a gluten sensitivity or celiac disease. In some cases the body's reaction to gluten can become quite severe. In these cases, the body starts to attack the central nervous system which may cause gluten ataxia. People who have issues digesting gluten may also develop digestive problems that cause damage to the small intestine. Gluten Ataxia usually starts off with mild symptoms, and gradually become worse over time. When left untreated the condition could lead to permanent damage. There is also evidence that people who suffer from gluten ataxia will show signs of cerebellar atrophy. Cerebellum atrophy is the shrinkage of the cerebellum. The cerebellum if the part of the brain located in the back of the head above the neck. The cerebellum is responsible for movement and has a direct impact on activities such as balance, speech, posture, walking and running. Gluten Ataxia is a relatively new discovery and thus not yet widely known to doctors and other medical professionals. This can make a diagnosis and proper treatment difficult to obtain. However, there are groups of researchers dedicated to spreading information abut this rare condition. As mentioned, it is a progressive condition, which means that symptoms may start off mild and almost unnoticed, and gradually progress to being debilitating. The symptoms of gluten ataxia are similar to symptoms of other ataxia conditions, which can make it tricky to get an accurate diagnosis. The symptoms appear in basic movements, such as walking or arm control, unsteady gait, difficulty walking, and loss of precise movement skills such as the ability to write or button a shirt. Parents should be on the lookout for ataxia symptoms in their kids. Children with celiac disease, specifically those in their early teens, would likely benefit from mental health evaluation. Strict adherence to the gluten-free diet does not mean you will never get gluten ataxia, especially for those who are not strict enough with their gluten-free diets. Some researchers have estimated that potentially up to 41 percent of all people with ataxia of unknown origin may have gluten ataxia. Other studies have indicated much lower numbers. A review of mental health studies indicated a prevalence of roughly 23 percent in patients with unexplained ataxia. In the last eight years or so the celiac community has finally been made aware of "gluten sensitivity" as a legitimate diagnosis. Twenty-five years ago you would not have heard of it, but now it has been given a rightful place along side of celiac disease and dermatitis herpetiformis. The same is true for gluten ataxia, its recent discovery will allow those who have it to say: "Finally, finally, someone is finally listening to me!" Read more at medicalnewstoday.com- 5 comments
-
Celiac.com 07/27/2017 - It was five years ago when I launched the concept of "gluten is bad for us all!" Yes, you read that right - bad for you, bad for me, and bad for everyone else! This implies that the whole world should avoid gluten. This is a bold and an unrealistic statement to make. However, I thought that there was enough evidence about the harm of gluten for us to demand massive changes to everyone's diet, our farming practices and food manufacturing industry. Eventually, this could substantially improve the health of our Nations. However the practicalities of such a change would be very difficult overcome. Especially with the economic forces of Big-Pharma, Big-Agriculture and Big-Government. I was not alone in thinking this. Many other medical/health professionals had also reached this conclusion with the growing research evidence of gluten-related diseases. Five years ago the top 15 celiac-doctors acknowledged that gluten-related-illness was a common problem that needed much better diagnostic tests. In their landmark paper "Spectrum of gluten-related disorders: consensus on new nomenclature and classification." http://www.biomedcentral.com/1741-7015/10/13, they concluded: "all individuals, even those with a low degree of risk, are susceptible to some form of gluten reaction during their life span." This publication was later expanded into a book. The description of this book is: "A Clinical Guide to Gluten-Related Disorders provides primary health care providers the succinct material they need to immediately evaluate and support their patients. Gluten-related disorders have a wide presentation, and this text covers the recognition, evaluation, and multi-disciplinary approach to the management of disease. Readers will benefit from the general overview of gluten intolerance and from the common sense approach to developing treatment and dietary plans. Clinical vignettes offer clinicians real-life scenarios to help put the disease and its treatment in context for their patients." I predicted, that in another generation, gluten will be rejected by most reputable food processing companies. This will be a difficult concept for many people to accept because wheat products are currently the very foundation of our diet. After 10,000 years of eating gluten grains it comes as a huge shock that our staple food has been demonstrated as harmful. Over the last five years I continue to see children and families made very unwell by eating gluten grains. It is also likely that that gluten may not be the sole culprit, as there are other wheat proteins that are toxic to humans. However, a gluten-free diet will eliminate these other wheat proteins. I have just seen Caleb who is 10 years old and was referred to me three months ago because of generalised intermittent abdominal pains. These pains come and go, but trouble him on most days of the week. These pains sometimes Bring him to tears, and on occasions he has presented to the emergency department at the hospital with severe abdominal pain. The usual investigations did not show up any specific abnormality, and his scans and x-rays for all within normal limits, other than showing that he had some constipation. He had also been suffering from sore throats and gastric reflux has been implicated, for which he was prescribed Omeprazole. In addition, he was not putting on much weight. My concluding remarks about him were "It is possible he is gluten intolerant. This could explain all of his symptoms (abdominal pain, constipation, gastric reflux, and tiredness). His mother has irritable bowel and has previously benefited from a gluten-free diet. I recommend that Caleb go on a three month trial of a gluten-free diet. His parents will let me know of his progress in three months time." Well, I've just seen him again following his three-month gluten-free trial. Mum said "what a difference! He now has regular bowel motions without the need for Macrogol, he no longer has abdominal pain and his reflux has disappeared and he is no longer needing Omeprazole. In addition he is growing again. With gluten infringements he gets a sore tummy, sore throat with some reflux and constipation again." It has taken Caleb a while to get into the swing of things. He still will eat gluten foods if he has the opportunity! He has to pay the consequences with his symptoms. He is also growing again. I am thrilled with his progress. He needs to stay gluten-free for the long haul. He needs to be as close to gluten zero as possible. He is lucky that both of his parents have joined him on his gluten-free diet. His mother is a lot better and has lost substantial weight, his dad also feels a lot more healthy on a gluten-free diet. Caleb is just one of millions of children who are currently suffering from guilty related diseases, but un-diagnosed and un-recognized. Yes, it was five years ago when I launched the concept of "gluten is bad for us all!" I have not change my opinion. Indeed, I am more confident about what I have written about the harm that gluten has caused throughout the world. I looked the 8 following questions. I wonder what your opinion might be: 1. Why pick on Gluten? 10 decades of Celiac; 10 years of Gluten Syndrome; 10 months of ZERO gluten. 2. Why is gluten so bad for us all? Cannot digest it; gut leaky; toxic proteins. 3. Why are there so many sick people? "Nobody knows what's wrong with me." Old technology for modern disease. 4. How much illness can be attributed to gluten? The catalogue of gluten-illness. Health burden of gluten. 5. Can gluten really damaged brains and nerves and minds? Brain symptoms, nerve damage, mental disorders. 6. What other illnesses might be linked to gluten? Auto-immune diseases. 7. Should we really change what we eat? Diet - not Drugs. The alternative grains. Health-giving foods. 8. How can we feed 7 billion people Is bad food better than no food? Gluten is bad for us all – the evidence for a gluten free planet. Warning: go gluten free now before it is too late. Written in the spirit of cooperation and knowledge sharing.
- 5 comments
-
- autoimmune diseases
- bad for us
- (and 7 more)
Celiac.com Sponsor (A8):
Celiac.com Sponsor (A8):
Celiac.com Sponsor (A8-M):