Celiac disease more prevalent in Multiple Sclerosis

[MSUK]

Celiac disease is more prevalent in patients with multiple sclerosis (MS) and their close relatives than in the general population, clinicians from Spain report.

Increased efforts aimed at early detection and dietary treatment of celiac disease among MS patients with tissue IgA–antitransglutaminase-2 antibodies "are advisable," they conclude in a report published online March 7 in BMC Neurology.

"We have found a prevalence of celiac disease among MS patients that is 5 to 10 times higher compared with the general population all over the world, which is between 1% and 2%," said first study author Luis Rodrigo, MD, from the Gastroenterology Service, Hospital Universitario Central de Asturias, in Oviedo, Spain.... Read More - http://www.msrc.co.uk/index.cfm/fuseact ... ageid/2190

[Wonderfulworld]

True in my case. I wish all neurologists tested for this on MS diagnosis.

Not only does undiagnosed coeliac disease or non-compliance with a 100% gluten-free diet cause malabsorbtion of vitamins/minerals, it also increases T-cell activation.
I had a massive improvement in my MS when I was diagnosed as a coeliac and went gf. My neurologist thinks there is a link between these illnesses.

I would BEG anyone with MS and any symptoms of 'IBS', to get tested properly by their doctors for Coeliac Disase - even if you have no symptoms of classic coeliac disease. Increasingly the symptoms of coeliac disease are changing to even include 'silent coeliac disease'.

To get tested for Coeliac Disease you need to increase the amount of gluten-containing food for 6 weeks Prior to getting tested- this means a few slices of bread each day for 6 weeks before you go for a blood test and a wheat-based cereal too. If the blood test your GP takes is positive for the antibodies, you then go for an endoscopy. You need to eat a good amount of gluten, all this time. You have the whole of your life to be gluten-free! The test period is only a couple of months, just in case you are put off by eating a lot of gluten for a few weeks.

Hope this helps even one other MS'er.
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[hwebb]

what a surprise - that Celiac disease...a disease which affects the endothelial lining in your digestive system....is related to CCSVI - a disease which affects the endothelial lining of your veins.

[Rokkit]

Several years ago (long before I had any other symptoms) I started having diarrhea after meals quite often, usually in the evening. I had a colonoscopy and was diagnosed with IBS. I hadn't heard of celiac disease then so I don't remember anything being said about it. Would I have necessarily been tested for celiac at that time?

[jimmylegs]

there is plenty of research to show that both celiac and ms patients are low in zinc, with implications for membrane integrity including intestinal epithelium, the blood brain barrier, vascular endothelium, etc.

celiac patients tend to be low in zinc due to malabsorption. i feel it is a bit of a chicken and egg situation and would hypothesize that suboptimal zinc might help lead to celiac disease, ie not enough zinc in a patient's system to handle the gluten load. that's a tough idea to back up with a study because the research all seems to focus on zinc status post dx.

i wonder what else, nutritionally speaking, ms and celiac patients might have in common..

[Perkele]

George Jelinek gives a good insight in this coeliac discussion:

There is a number of researchers who contend that, in an evolutionary sense, legumes, and gluten in cereals, are relatively recent additions to the human diet. These protein-rich foods may be implicated in a host of auto-immune diseases including MS. The most severe form of gluten intolerance is coeliac disease. Here, people develop serious digestive system disorders due to an immune response to the gluten in wheat. One might expect, if gluten was a key ingredient in the diet to avoid in MS that people with MS might have a higher than usual incidence of coeliac disease, or vice versa, that people with coeliac disease might have a higher than expected incidence of MS. A major population study published in mid-2007 examined 14 000 people in Sweden with coeliac disease and compared them with 70 000 other people without the disease acting as controls.1 One would have expected a higher rate of MS (or other CNS degenerative disease) in those people with coeliac disease than controls if gluten was involved in causing these diseases. In fact the researchers found no statistically significant association between coeliac disease and subsequent multiple sclerosis, Parkinson's disease, Alzheimer's disease, hereditary ataxia, the symptom ataxia, Huntington's disease, myasthenia gravis or spinal muscular atrophy. This is very strong evidence that there is no link with gluten.

If there was indeed a link, one should at least expect to find in people with MS antibodies to gluten which indicate intolerance. In fact, Italian researchers looking at 95 patients with MS found not a single patient with elevated antibody levels.2 UK researchers tested 49 patients with MS for their antibody levels and found 12% had raised levels; however this compared with 13% of unselected blood donors, so it was unlikely that people with MS had any special sensitivity to gluten.3 Iranian researchers tested 166 people with MS for antibodies and compared them to people without MS.4 They found no difference in antibody levels.

Italian researchers used an alternative approach to investigate this problem. They fed a gluten-free diet to animals with the experimental form of MS, EAE. The animals on the gluten-free diet initially had a more severe disease course.5 Later, they seemed to be doing better than those animals eating gluten. The study in my view provided an indeterminate result.

The molecular mimickry theory of MS causation is perfectly valid, and probably explains why cow's milk protein for example sets off the chain of events leading to myelin attack by the immune system. We now have good evidence from the laboratory that a segment of cow's milk protein is identical to a segment of myelin oligodendrocyte glycoprotein. The immune system, in setting up defence against this foreign protein, is 'tricked' into also attacking this part of myelin. Whenever something like this is proposed as an explanation for the immune attack on myelin, it is important to validate it against what we actually see in human populations.

For cow's milk, this is easy. The world map of MS distribution is almost exactly the same as the world map of cow's milk consumption. That is, there is almost a direct correlation epidemiologically between cow's milk consumption and MS incidence. This is a kind of 'cross check' if you like, that the theory is correct. As a result, I strongly advise people to avoid cow's milk.

For gluten for example (or tomato for that matter), there are several major problems with the theory. Firstly, there is no clear biochemical similarity between part of the gluten compound and myelin as far as I am aware. Secondly, when we run the epidemiological cross-check, populations that consume wheat do not appear to have a higher incidence than other populations. A further cross-check is to see whether people who do develop auto-immunity to wheat (those with coeliac disease) also get auto-immunity to myelin; the data show that there is not a higher incidence of coeliac disease in those with MS or vice versa. And finally, the animal data don't support a link either.

So I advise people that gluten should be relatively safe. It is important to try to base these recommendations on evidence, not just theory, and I feel comfortable that the evidence does not support a link with gluten sufficiently to make a recommendation to avoid it. Overall, the evidence of any effect of gluten in MS is not convincing enough to warrant changing my own diet to exclude wheat products.

References

1. Ludvigsson JF, Olsson T, Ekbom A, et al. A population-based study of coeliac disease, neurodegenerative and neuroinflammatory diseases. Aliment Pharmacol Ther 2007; 25:1317-1327
2. Salvatore S, Finazzi S, Ghezzi A, et al. Multiple sclerosis and celiac disease: is there an increased risk? Mult Scler 2004; 10:711-712
3. Pengiran Tengah CD, Lock RJ, Unsworth DJ, et al. Multiple sclerosis and occult gluten sensitivity. Neurology 2004; 62:2326-2327
4. Borhani Haghighi A, Ansari N, Mokhtari M, et al. Multiple sclerosis and gluten sensitivity. Clin Neurol Neurosurg 2007
5. Di Marco R, Mangano K, Quattrocchi C, et al. Exacerbation of protracted-relapsing experimental allergic encephalomyelitis in DA rats by gluten- free diet. Apmis 2004; 112:651-655

[Wonderfulworld]

I had a colonoscopy and was diagnosed with IBS. I hadn't heard of celiac disease then so I don't remember anything being said about it. Would I have necessarily been tested for celiac at that time?

Rokkit not neccessarily - coeliac testing is 2 part - a screening blood test for Anti-tTG/IgA, if positive then a jejeunal biopsy is peformed via an endoscopic examination.

If you are eating gluten on a daily basis maybe you should just have a blood test to rule it out, if nothing else. I was diganosed with IBS at age 20, this was amended to Coeliac Disease by the time I was 31.

In the UK I noticed recently that guidelines stipulate that to diagnose anyone with IBS, Coeliac Disease must first be ruled out. This is because Coeliac Disease is too often misdiagnosed as IBS.

George Jelinek gives a good insight in this coeliac discussion:

Perkele I think this is flatly contradicting the study in BMC Neurology.
His mention that:

So I advise people that gluten should be relatively safe.

should perhaps come with a proviso...that it should be ruled out by a blood test first.

I was considered 'worsening RR-MS' and advised to take Mitoxantrone before I was dx'd with Coeliac Disease. After my dx and adherance to GF diet I have moved back into RR-MS territory with a reduction in my EDSS score. To complicate things slightly I started Copaxone around the same time and gave up smoking, so a scientific statement it is not, but all the same if I could just save one other person with MS from having undiagnosed CD, I'd be very happy.

[jimmylegs]

that whole thing about milk and ms doesn't sit right with me - 15 year vegan dxd with ms.

[tara97]

when I told my gI doc that I thought I really had porphyria he tested me for celiacs in the hla histone compatability complex test to see if I had markers for celiacs. he said that celiacs has a high occurance with porphyria. I will say it again as if it werent getting old porphyria causes ms. hemochromatosis and porphyria cutania tarda are prooven to be related illnesses. anyway perhaps its not as obvious to others as it is to me perhaps because i am a paranoid conspiracy theorist lol. solient green is people and porphyria is MS!!

[jimmylegs]

definitely could be the case for some.

porphyria testing info for newcomers to the subject.

http://archderm.ama-assn.org/cgi/conten ... 133/9/1098
Screening of Patients With Iron Overload to Identify Hemochromatosis and Porphyria Cutanea Tarda
"A high serum ferritin level in the absence of evident cause should prompt investigation for both hemochromatosis and PCT. "

(might want to start thinking of looking at causes of high ferritin if up over 200 ng/ml)
http://www.labtestsonline.org/understan ... /test.html

"Porphyrin testing is used to help diagnose and sometimes to monitor porphyrias...

Tests for PBG and porphyrins may be ordered on a random urine specimen when a patient has symptoms that suggest an acute porphyria, such as abdominal pain, nausea, constipation, peripheral neuropathy (tingling, numbness, or pain in the hands and feet), muscle weakness, urinary retention, confusion, and hallucinations. When the initial tests are abnormal, these tests should be repeated on a 24-hour urine collection to determine how much PBG, ALA, and porphyrins are being excreted. Fecal porphyrin testing may be ordered to help distinguish between porphyrias.
Depending upon the patient’s age and symptoms, a test for urine porphyrins and/or the free erythrocyte protoporphyrin test should be ordered when a patient presents with blisters, scarring, redness, or other skin lesions in sun-exposed areas. A positive urine test is followed by analysis of a 24-hour urine collection to determine which porphyrins are present.

Enzyme testing is most commonly ordered to confirm the diagnosis of acute intermittent porphyria (porphobilinogen deaminase in red blood cells). This test is especially helpful in identifying family members of a known patient who have inherited the disease but have not yet developed signs or symptoms. Some reference laboratories can measure porphyrins in plasma, bile or other fluids, but this is not usually necessary to make a diagnosis."

[leeyn]

To get tested for Coeliac Disease you need to increase the amount of gluten-containing food for 6 weeks Prior to getting tested- this means a few slices of bread each day for 6 weeks before you go for a blood test and a wheat-based cereal too....