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Old 01-08-2010, 08:43 AM
Prot Prot is offline
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Default Celiac Disease Increases Risk of Neurological and Psychiatric Disorders

Migraine and carpal tunnel syndrome are common among celiac patients, a new study shows.

After screening a cohort of 72 patients with biopsy-proven celiac disease, researchers also report that many experience psychiatric problems, with 35% of celiac patients reporting a history of depression, personality changes, or psychosis.

Atypical neurological presentations are thought to occur in 6% to 10% of celiac patients, the study authors note. Prior studies have suggested that cerebellar ataxia is the most frequent symptom. This new study observed cerebellar ataxia in 6% of patients. Another 6% had vestibular dysfunction. In all, 26% of patients experienced afferent ataxia.

About a third of patients had stance and gait problems, and many experienced deep sensory loss and reduced ankle reflexes.

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

Neurological problems may develop despite strict adherence to a gluten-free diet.

The study is published in the December 15 issue of Movement Disorders.

Observation Bias

The 72 patients with celiac disease were recruited through advertisements and interviewed using a standard questionnaire.

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

About a third of celiac patients (28%) reported a history of migraine. In many cases, there was a decrease in the frequency and intensity of migraine attacks after the introduction of a gluten-free diet.

About 20% of patients experienced carpal tunnel syndrome. "Surprisingly, epilepsy was less common than expected," report the researchers. "Only 4 individuals presented with a history of generalized or focal seizures."

Motor problems, such as basal ganglia symptoms, pyramidal tract signs, tics, and myoclonus, were infrequent. A total of 14% of patients reported bladder dysfunction.

Multiple Mechanisms Likely

In celiac disease, the mechanisms leading to neurological disease are not yet understood. Deficiencies in folic acid, vitamin E, and biopterin have been implicated in the pathogenesis; however, the investigators report that replacement therapy does not resolve clinical symptoms in most cases.

The researchers point out that hypovitaminosis rarely causes overt abnormalities in celiac patients, and most with neurological symptoms do not show evidence of any nutritional deficiencies.

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

The investigators suggest that because of the considerable clinical variability, many different pathogenic mechanisms are likely to contribute to the neurological and psychiatric dysfunction in celiac disease.

The researchers have disclosed no relevant financial relationships.

Mov Disord. 2009;24:2358-2362.

http://www.medscape.com/viewarticle/714823
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Old 01-08-2010, 02:02 PM
jcc jcc is offline
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Thanks so much for this post! I had not seen this article on medscape yet, although I think I remember seeing the original study it is talking about..

I will surely pass it along and add it to The Gluten File.

Thanks again!

Cara
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Old 01-08-2010, 04:17 PM
Zonulin Zonulin is offline
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Thanks for posting this - I know a woman who has debilitating migraines and her sons have been diagnosed with Aspergers Syndrome and they all eat gluten like mad. She has no interest in ordering the Antigliadin IgG Antibody test for any family member. Crazy?

Karen
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Old 01-08-2010, 07:00 PM
Naominjw Naominjw is offline
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Often, the falling down is blamed on the psych meds. Then the meds get changed, and the person is still falling down. I recall my daughter was falling down a lot before ever starting on psych meds, and it just got worse and worse. Falling down was associated with the migraines but happened other times as well. But we were told migraines are more common with seizures and psych diagnoses.

Seems like everything was blamed on having the psychiatric issue instead of telling us that something underlying it all was causing ALL these symptoms of neurological and psychiatric disorders - falling, migraines, pain, depression, etc. But - we really did suspect that ALL of it was intertwined, and we were desperate for doctors to look at ALL of her symptoms together - but you know how specialists are.

The article said: "The patients' gluten-free diet had resolved intestinal symptoms but had not prevented the development of neurological deficits."

My daughter needed food supplements to help mitochondrial function which stress greatly affects. She needed multinutritional supplements, help for sleep, vitamin D, and hormones which they really weren't looking at for years. In other words, there was a broad whole-body response going on, and her entire health had to be addressed and improved. Doctors need to look at the whole picture. I sound like a broken record.

Now, no need for mood stabilizer meds, antipsychotics, or migraine meds.

But it is amazing that many people do not feel they can give up some foods "for anything." I don't get that. Karen - I kind of understand not testing children. My dad kept harping about Celiac, but I dismissed it because the doctors didn't seem concerned about it, and I didn't have all this research at my fingertips back then. And the GP finally ran one blood test and it was negative. I was... ignorant. But what misery could have been avoided if we'd known sooner. I know a lot of us wish we could scream what we learned from a mountaintop.

My only symptoms I knew of were chronic hives. Now that I am off gluten I am thinking it also aggravated my arthritis.
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Old 01-08-2010, 11:13 PM
jcc jcc is offline
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I can certainly relate to what you say, Naominjw! And yes, if they look "ONLY" to a gluten free diet, they may be missing other important pieces. Gluten is a biggie, but not the only thing.
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Old 01-09-2010, 09:07 AM
glenntaj glenntaj is offline
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Default As far as I'm concerned--

--and I'm sure the Gluten File will back me up, this is actually old news.

There've been many papers over the last decade indicating that celiac/gluten sensitivity can present without overt gastric or dermatitis symptoms, and that the most common presentations are neurologic--ataxia, myoclonus, peripheral neuropathy (especially small-fiber).

I am, of course, very close to a lot of this, having been treated at the Cornell-Weill Center for Peripheral Neuropathy, where a lot of this reserach that didn't originate with Dr. Hadjivassiliou originated from.

Specifically, the Center's empahsis on autoimmune mechanisms has led them to suspect that the gliadin peptides may cross-react with ganglioside components of peripherla nerve in certain structurally susceptible individuals, or with cerebellar Purkinje cells in others (and I'm sure JCC can provide the appropriate references). This is in addition to and seperate from the neurologic consequences that can result from malabsorption of nutrients.

The real value in this paper is in adding to the chorus reminding doctors that celiac/gluten sensitivity IS NOT ALWAYS CHARACTERIZED BY OBVIOUS GASTRIC SYMPTOMS. (And yes, I am yelling--I've had to yell at doctors and bring in papers.)
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Old 01-09-2010, 01:13 PM
Ted Hutchinson Ted Hutchinson is offline
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Quote:
Originally Posted by Prot View Post
Migraine and carpal tunnel syndrome are common among celiac patients, a new study shows.
As I am sure all three conditions involve inflammation.

Certainly people with celiac use up Vitamin D3 at a rate at least double that of normal folk and most are severely vitamin D deficient most of the time.
Generally it takes Celiacs 2000iu/daily to raise status 10ng/ml.

Celiac and Vitamin D3

Celiac patients should be encouraged to keep 25(OH)D3 levels towards the upper range of normal.
Nearer to 80ng/ml than 60ng/ml.
They would then have a greater reserve of anti inflammatory Vitamin D3 stored in their brains/bodies and thus be in a better situation to deal with the inflammation their condition generates.

Vitamin D3 isn't the cure for Celiac, eliminating gluten is probably the best long term solution, but there are many benefits to having optimum vitamin D status and one of them, better control of Neurological and Psychiatric Disorders, is definitely worthwhile.
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Old 01-09-2010, 03:02 PM
jcc jcc is offline
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Yes, I've known many celiacs and gluten sensitive individuals who have tested extremetly deficient in vitamin D. I would agree that the vast majority need it.
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