Friday, December 29, 2006

Celiac diease, gluten and the brain-gut connection supported by finding of intestinal and brain antibody deposits.

Antibodies for tissue transglutaminase found in intestine of blood test negative celiac disease are also found in intestine and brain in people with brain disease due to gluten. Gluten ataxia is a brain disorder characterized by balance disturbance not explained by any other cause but due to ingestion of gluten. The disorder responds to a gluten free diet if irreversible brain damage has not already occurred. Calcifications can be seen in the brain on magnetic resonance imaging (MRI).

Deposits of gluten related antibodies have been found in brain tissue obtained on biopsy and autopsy specimens. Mario Hadjivassiliou, M.D. from Sheffield England recommends gluten ataxia be added to a list of gluten related diseases that includes peripheral neuropathy and the skin disorder dermatitis herpetiformis. He has called for a new paradigm to be accepted where celiac disease is not considered primarily as an intestinal disease.

Dr. Hadjivassiliou and colleagues recently published a report of nine patients with gluten ataxia compared with seven patients with ataxia due to other causes. They found tissue transglutaminase IgA deposition on jejunum intestinal tissue on all nine patients with gluten ataxia but none of the control patients. Brain tissue from an autopsy of one patient with gluten ataxia was also found to have IgA tTG deposits in the cerebellum, pons and medulla of the brain but not in a control brain.

Previous studies have found negative blood celiac blood tests in patients with gluten ataxia suggesting that they may not have celiac though they had gluten related disease. In light of a new report that blood test negative celiac disease can have intestinal tTG and advanced intestinal damage it is curious to wonder if the gluten ataxia patients with blood tests negative are seronegative celiac disease. It is increasingly appearing that there is a very broad spectrum of gluten related disease and there are non-celiac gluten related symptoms that include the brain, skin, musculoskeletal system as well as the gut.

Many patients I have seen with gluten sensitivity describe symptoms of balance difficulty, concentration problems or “brain fog”, headaches, and neuropathy and a few report symptoms such as “bug crawling” sensations and strange muscle twitches. These symptoms commonly improve with gluten-free diet and return with intentional or accidental gluten exposure. In some intestinal symptoms or skin rashes occur, often at the same time as the onset of the brain symptoms but some don't have any gut symptoms. The concept of gluten as a cause of brain symptoms is still not one widely known or accepted by many doctors, especially in the United States. However in Europe, especially England, Germany and Scandinavian countries, as well as Australia and New Zealand the gluten brain-gut connection is more accepted.

The concept that casein, the major milk protein, causes brain symptoms that imrove on a dairy-free diet, casein-free diet, is also not commonly accepted by doctors in the U.S. though many lay public organizations and support groups have found casein-free diet to be associated with improvement of brain function as well as helping autism.

What is needed is more openness of U.S. doctors to role of diet and foods in such symptoms and diseases and much more scientific research. I ask you to join me on the journey of the food, bacteria, gut-brain-joint-skin connection to disease and health. You may help spread the word through e-mailing this post to others by clicking on the letter icon below. You may subscribe to the Food Doc blog by clicking on subscribe to this post atom on the right side of this post so that you will be automatically alerted to my new posts.

Autoantibody targeting of brain and intestinal transglutaminase in gluten ataxia. Hadjivassiliou M. et. al. Neurology 2006; 66:373-377.

Endomysial antibody-negative coeliac disease: clinical characteristics and intestinal autoantibody deposits. Gut 2006; 55:1746-1753.

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